Violent fantasies

National Review, July 20, 1998 by Sally Satel, D.J. Jaffe

A MacArthur Foundation study found that the mentally ill are no more violent than anyone else. Can it possibly be true?

Last May, Raymond Cook went on trial for first-degree murder in the death four years ago of Thomas J. Guinta, a police officer in Fall River, Massachusetts. The same day that Cook shot Guinta, he spared the life of a longtime neighbor because he mistook her for a movie star who had played opposite James Cagney.

The day before Easter, 26-year-old Keith Powell of Red Oak, North Carolina, showed up with a shotgun at his aunt Louise's birthday party and killed his grandfather and two uncles. Months earlier when he walked away from his group home, his mother knew that he had quit taking his medication, and she feared that the voices in his head would soon return. After the shootings, Powell committed suicide.

In the most spectacular recent case, Michael B. Laudor of Hastings-on-Hudson, New York, a brilliant Yale Law School graduate who seemed to have beaten back his mental illness (he was working on a screenplay based on his successful fight) allegedly stabbed his girlfriend to death. He too had stopped taking his medication, and his mother had become so alarmed that she asked police to check on him shortly before his girlfriend's body was found.

Cook, Powell, and Laudor all suffered from schizophrenia. Lacking adequate treatment, they became deranged and violent. Homicide, to be sure, is rare even among schizophrenics, and yet untreated psychosis is so intimately linked to aggression that mental hospitals routinely rely on locked wards and often use physical restraints to control patients until antipsychotic medications take effect.

The connection between certain types of severe mental illness and violence would seem to be a matter of common sense. But until the 1960s, when deinstitutionalization began in earnest, most of the severest cases were out of sight, helping people forget how volatile the psychotic can be. And in the 1970s a movement focused on reducing the stigma of mental illness, and hence downplaying the risk of violence, became better organized and more influential. Thus, the old common-sense view became increasingly controversial.

Now a new study from the MacArthur Foundation says the notion that people with serious mental illnesses may be particularly prone to violence is little more than a stigmatizing myth. The study got wide play in the media--including front-page coverage in the New York Times and some sensational headlines--from the AP, "Mentally Ill Not Especially Violent" and from the Washington Post, "Are Former Mental Patients more Violent? If they Don't Abuse Drugs and Alcohol the Answer is Generally No, Study Finds." It could have a major impact on the running debate over involuntary-treatment laws by providing ammunition to civil libertarians and advocates for the mentally ill who believe that ill people should be left to wallow in their psychosis, haunting the streets of our cities.

The MacArthur findings were published in the May issue of the prestigious Archives of General Psychiatry, under the title "Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods." The study does admit that drugs and alcohol increase violence in people with mental illness more than they do in the general population, but it concludes that, otherwise, these people are no more violent than anyone else.

This contradicts the findings of numerous studies over the last thirty years. For example, a study of three hundred patients discharged from California's Napa State Hospital between 1972 and 1975 showed they had an arrest rate for violent crimes ten times higher than the general population. A 1994 British study of schizophrenics in Camberwell found that they were four to five times more likely than their neighbors to be convicted on charges involving serious violence. How did the authors of the MacArthur Violence Risk Assessment Study, all prominent researchers, come to such a radically different conclusion?

First, they excluded many potentially violent people by the way they constructed their sample, such as persons who were currently in or recently released from a prison, jail, forensic hospital, or long-term psychiatric hospital. "We always teach medical students that past violence is the best predictor of future violence," says psychiatrist and schizophrenia researcher E. Fuller Torrey. "While purporting to study violence, the first thing the authors did was omit violent people from the study."

The researchers limited the study to patients in acute-care hospitals. Only one in ten patients stayed longer than thirty days with half of all patients successfully treated and released in under nine days. This largely eliminated anyone too sick to be stabilized acutely, again reducing the chance of including non-psychotic individuals. Among those asked to participate, 29 per cent refused; a disproportionate number were suffering from schizophrenia, the very disorder which, if untreated, is most likely to result in violence.