Thursday, January 10, 2008

Violence and Schizophrenia – Comments from Readers

I would like to thank all those who commented recently on my posts “Violence and Schizophrenia”. Often I find that the comments left by readers are more interesting and informative than the posts I have written! Some of the explanations of what it is like to suffer violent intrusive thoughts were too valuable to leave unread by the majority in the comments section.

“The thoughts are like movies you can't shut off... no matter how horrible it is I can't press stop… I'm forced to "watch" the whole thing until it is done.”
- Minnesnowta

“I've struggled with these thoughts for a long, long time. I thought they made me a horrible person and I have done very silly things to try and erase them from my mind. I could not even write them down for fear that they would become more real.”
– Anonymous

“They cause great distress, and I wonder why my head does this to me? I don’t like swatting wasps, let alone harming a person; it’s just not me at all.”
- Slurry

I also sometimes receive comments which raise very interesting questions and points of view. No doubt these points of view will be shared by others, and so I would like to reply in full in a blog post. I have recently received the following comment from an Anonymous reader, regarding my posts on Violence and Schizophrenia.

“I have been reading your journal with interest and after some time have decided to post a reply to this thread.

On the topic of intrusive thoughts my guess is that we all have these and from time to time they can be elaborate, explicit and violent but a filter or whatever prevents us from taking these fantasies and enacting them in the real world. If this were not close to the mark I fail to understand the attraction that violent films and latterly computer games have for a large proportion of the population. In fact, children may re-enact what they have seen but as play rather than through real aggression.

I am reluctant to continue this post as I believe it will be unpopular with the non sufferers of schizophrenia and those with the illness who read this blog. However my opinion is as valid as anyone else’s and deserves to be considered.

A small percentage of people with serious mental illness are capable of the most appalling violence. I know of no way to differentiate those who will go on to kill and those who will not. I believe that by claiming that there are far worse dangers out there you are bordering on denial. There are many dangers out there, far more people are killed by the sane than the mentally ill but a percentage of schizophrenics will go on to kill.

Even a small percentage is significant, I personally know of no one who has been killed by a seriously mentally ill person. I have however been stabbed over a prolonged period by one and am lucky not to be one of the statistics I feel some would rather ignore.”

Anonymous, thank you for taking the time to respond to my posts “Violence and Schizophrenia”. Firstly I would like to say how sorry I am that you have been a victim of violence over a period of time. As you so rightly point out, your opinion deserves as much consideration as anyone else’s.

You begin your comments by stating:
“On the topic of intrusive thoughts my guess is that we all have these and from time to time they can be elaborate, explicit and violent but a filter or whatever prevents us from taking these fantasies and enacting them in the real world.”

I personally don’t believe that I have ever experienced intrusive thoughts. In rage I have experienced very violent thoughts, but as I endeavoured to explain in my previous post on the subject, intrusive thoughts are unrelated to the person’s emotional state and additionally are “intrusive” – unwanted, unwelcome, distressing, and difficult to be distracted from. Far from being a fantasy, they are more like a waking nightmare for those who experience them, especially as they can be accompanied by visual hallucinations. See the comments above by those who have experienced them.

You continue:
“If this were not close to the mark I fail to understand the attraction that violent films and latterly computer games have for a large proportion of the population.”

This is an interesting point. For Mr Man, the intrusive thoughts and hallucinations that he has endured means that there is rarely a violent scene in films that he finds more distressing than what he has already witnessed. However, this doesn’t mean that he finds violent films entertaining.

For most people who are entertained by such, I suspect that it is more than simply a case of desensitization. Over the years films have not only become increasingly violent, but the violence has been glorified by being acted out by the most popular actors delivering “cool” one liners. In addition, age restrictions have been reduced and the video games often allow the gamer to become the hero of the film. Violence then has become synonymous with many desired traits such as popularity, admiration, and sex appeal, to name but a few, and I feel it is this that has increased its popularity.

Like you, I fail to understand the attraction of such violent “entertainment”, but the result of which for many is an impaired conscience, which I believe you alluded to when you said “a filter or whatever prevents us from taking these fantasies and enacting them”. For some, the filter stops working. Despite suffering from intrusive thoughts, the conscience of a person with mental illness is no more likely to become impaired than anyone else’s. As Mr Ian, a psychiatric nurse for many years, said in the comments section:

“Most people with psychoses harm themselves before other people as they still maintain their moral reasoning that it is wrong to hurt others. Those that do harm others, only do so because they feel they are severely threatened, regard it as the best/only option for their dilemma, or they have a delusional belief that such behaviour is 'ok' (I once nursed a guy who stabbed a horse guardsman in the leg because [he believed] it was an act of mutual bonding and honour that the guardsman would have understood).”

You continue:
“A small percentage of people with serious mental illness are capable of the most appalling violence.”

I agree, just as a percentage of those without mental illness are capable of equally appalling violence.

“I know of no way to differentiate those who will go on to kill and those who will not.”

Again, I agree, just as I have no way of knowing which of those without mental illness will go on to kill and which ones will not.

"On Balance" by Philippa King

“I believe that by claiming that there are far worse dangers out there you are bordering on denial.”

I never claimed that there were far worse dangers, only that a person has as much chance of being killed by a person without mental illness as with. What I do question is whether a person’s mental illness is truly the cause of their violent acts in all cases. In many cases I think it is used as an excuse; on the other hand, for those who clearly were affected by mental illness at the time of committing a violent crime, support was obviously lacking as there are always warning signs before hand. Consider this comment by Mr Ian:

“In regard the myth of the "snap" theory, I agree. It never comes unannounced. It frequently goes unnoticed or unattended though. I have worked with violent mentally disordered offenders for several years now. What you say is true and accurate from my perspective also; that the true cause of the violent act being purely in psychotic reasoning is pretty rare. Often it is increased in probability by prior personality, intellectual or environmental influences; or is more to do with those predisposing/predictive factors and not psychoses at all.”

You continue:
“There are many dangers out there, far more people are killed by the sane than the mentally ill but a percentage of schizophrenics will go on to kill.

Even a small percentage is significant”

I agree that although the percentage of those killed by people with mental illness is small, those victims are not insignificant. However, I think it is unfair for the media to wrongly give the impression that these murders are more frequent than they actually are, or that everyone with a mental illness is violent. Rather than trying to ignore statistics, I am asking people to be balanced in their view of people with mental health problems.

I understand that your experience has not been a good one. You don’t say what your relationship is to the individual who has stabbed you, but I would recommend seeking outside help and advice from a GP or a Community Mental Health Team. If this person is persistently violent towards you he/she should either be arrested or detained in a secure unit under a section of the mental health act.

Thank you again for your comment, and to all who have commented on this subject.

Related Posts: Violence and Schizophrenia - Part One, Violence and Schizophrenia - Part two

Related Posts on Mental Nurse: The Will To Do No Wrong, The Will To Do No Wrong Part 2


Anonymous said...

I have a young son who has "symptoms." I find your site to be informative. We are in the middle of evaluations. Thank you for your writing and sharing. sincerely, dg

Mr Mans Wife said...

DG, thank you for your comment and welcome to my blog. I'm glad you have found my blog to be informative.

No doubt this is a difficult time for you and your family. I hope you can find the information and the support that you need. Please feel free to ask questions or just let off steam here whenever you feel the need.

Mr Ian said...

Wow.. long post.. much quoting... me thinking... did I say that? ;o)

To add (substantially) to your comments:
I think the mental illness/violence misrepresented synonymity..hmm... ok.. rephrase...

I think the presumptive generalised bollox that people with Mental Illness are violent is akin to how "delusions" are formed - an ember or kindling spark can quickly turn into a raging fire if given the right circumstances - usually glorified media, public/press ignorance and the synergic consequence of public hysteria are to blame.
However, in cases such as Christopher Clunis/Jonathon Zito, there is a clear recognition that in some instances, the distorted thinking symptomatic of mental illness places a huge weight on the causality behind a person acting out violently. However, this is not a personality aspect that can be singled out as the unique and isolated cause (unless it involves perceived extreme life-threatening fear - such as one might do if a gun were pointed at you - or you believed the person standing next to you was about to inject your brain with HIV); it also needs other pre-disposing factors such as violent experiences (received or given) and poor cognitive ability (for problem-solving, rationalising or reasoning, etc).
I understand the concerns of Jo Public that arise in regard the sensationalism that media give to such events, but the emphasis is always placed on the 'fact' that the person is mentally ill - not that they may have been beaten soundly as a child, or came from a socially deprived background with poor educational opportunities.
The opinion makers (mostly media) simply grab onto one "fact" (and lets make it the one least understood so we can keep that mystical yet patroninsing nature about the story going) and emphasise everything we can on that.
The reality is, if a person with a mental illness diagnosis commits a violent act, the stats will show that to be 'violence by a mentally ill person'; even tho the violence might be nothing to do with the 'illness' directly or even indirectly. I'm not sure how the stats are collated on violence, but I would suggest it's non-mental health workers; eg police officer attending a domestic sees old Fred again just discharged from hospital - ergo, he must be acting mental again, as that is his previous "MO", back in on a s136 or call for an Approved Social Worker to s2 him - who will because the alternative of a night in jail would mess him up. Tick placed in "violence - mental health related" as it's very often a case of finding the right box to tick; not analysing the true situation.
Having said (or typed) all that; the presence of mental illness can increase the risk of violence - but IF that mental illness causes fear of harm from others - AND the aforementioned predisposing factors are also evident in sufficient weighing to cause the person to believe and to have the ability to carry out any assault.
Most people don't have the other two predisposing factors, mentally ill or otherwise. Many others have the two factors alone and don't need to add a 'mental illness' to pass the threshold.
As a rough guide to violent behaviour for ANYONE(and there's probably other factors I'm missing here):
If a+b+c > moral reasoning = violence - where
a) is level of previous exposure to violence;
(b) is level of impairment of cognitive ability to deal with it, and
(c) is level of any other factor: it could be "mental illness", or no money, or no food, or a bad day, or political beliefs, or religion, or previous bad dealings with that person, or sense of injustice or even just they support the wrong football team, or any combination of those and more.
Mental illness does not generally exceed moral reasoning in itself; and it certainly is no more likely to lead to violence than any of the others listed at (c) - just depends on how bad (c) is for that person.

As for the "intrusive thoughts", hell I sometimes want to smack the crap out of some people - especially when I perceive them to be acting like utter (c)'s

Anonymous said...

Thank you for your considered response to my post under Violence and Schizophrenia Part II. I hope you will understand my desire to remain anonymous and therefore not wanting to give too many details about the incident or the family history but I will elaborate a bit further.

My attacker (X) is a close member of family who has suffered a serious mental illness for many years. We now know this to be schizophrenia though it took quite some time for a formal diagnosis to be given. The illness manifests itself through delusional thinking especially with respect to family members (and their imaginary counterparts) and an inability to recognise boundaries resulting, at times in innapropriate behaviour. No doubt there are other affects but as X is unwilling to describe their feelings during bad times it is less clear what they are.

At the time of the attack X was suffering severe confusion and distress. We had tried to get all the help available and the services were in close contact but I suspect no one really believed that the situation would deteriorate so rapidly and disastrously. I am as guilty as anyone else here and thought that so long as the situation was kept safe and calm and X could be pursuaded to take medication regularly again then everything would be OK. After all thats the way things usually turned out.
Except we were wrong.

Ultimately, my hope and my denial almost killed me.
Perhaps X suffers from more than schizophrenia or maybe has a discreet instinct to kill but I have no way of untangling X's mental turmoil and neatly catagorising the various facets that comprise the illness. And now I have no desire to do so, I have no wish to have anything to do with X again.

It is not my intention to be sensationalist, or to tar anyone with the same brush or to argue that this may be in store for you. This has left me damaged and raw and so I needed to speak out. I have been left trusting no-one and wishing that the only thing I had ever listened to was my instincts.

There is to be be a trial, and an inquiry. No worries there, the powers that be very quickly chose their scapegoats.

Anonymous said...

To Anon, and if MWW does not mind my responding to the comment:
I regret your experiences and, without detracting from anything I personally have said, believe that your case may warrant concern towards those who are so mentally compromised as to increase their risk beyond acceptable - patently evident by the nature of assaults on yourself.
Although you sound rightfully bitter and angry, you also seem to carry a sense of rationality in your comments that validates the victim position of those people disaffected by those people who are mentally ill. It is for this exact purpose that the Mental Health Act exists. There is not sufficient details for me to suggest where the system may have failed; except to say, by the outcome alone, it would appear to have failed you and the person who assaulted you.
As I said before; presence of mental illness by itself does not suggest that violence will occur unless that illness is clearly presenting a (perceived) threat to the individuals safety - it does increase risk, and where other factors are also compromised, risk is there.

"The illness manifests itself through delusional thinking especially with respect to family members (and their imaginary counterparts) and an inability to recognise boundaries resulting, at times in innapropriate behaviour"

The delusional, and I'm assuming paranoic, thinking that this person demonstrates would constitute a high risk: where specific people are identified; access to those person exists; the nature of the delusions is threatening to the individual - this would raise concerns for me (as a professional) if he began to distrust those around him.

It would appear, in this instance, his mental illness risk was sufficient to warrant concern; along with the risks I have already identified, this is what leads to the individual becoming one of the 1% of those that do.

It also has led to you being a victim.

Anonymous said...

i have this experience....

this is happened in 2004, my husband just got back from hospital.... he and i just got a jetski accident, he drive it so fast till we fall. N t turns out he tried to drawn him self but we manage to saved him.

He told me to close our bed room window and i forgot. He thought i was waiting for a guy, so he slap me when i was sleeping and grab my neck so tight till i hardly can breath. I was so scare and i thought it was my time, but i try to calm n try to calm him down as well, it work cs luckily ther someone out side our room. when i told this to his brother and he tried to confirm it to him, he denied, he said i was over react.

He is oke now, just got out from hospital from relapse again, oktober 2007. But since then i feel insecure, and when i could not bear it i prefer to sleep on the sofa out side our room.

Do u think that kind of moment could happend again ? Cause i m not sure will that lucky :(.


Mr Mans Wife said...

Firstly, my apologies for not replying to the above comments sooner. Blame Mr Ian for writing such a lengthy comment for me to read!! Blimey, I thought I went all round the houses…

Just kidding Mr Ian. Thank you for your comment. I suppose we really don’t know what makes some people violent and others not, do we? As you said, if A + B + C is greater than the persons moral reasoning then that equals violence, but on the other hand you say that most people don’t have A and B, and others have A and B but not C. So really, all we can say is that everyone has the capability of being violent, mentally ill or not.

Anonymous, I am grateful that you took the time to respond to this post. I hope you didn’t mind me replying to your previous comments in a blog post.

Unfortunately, as you have learned, regularly taking medication doesn’t necessarily mean that a person with Schizophrenia will stay well as there are many triggers.

I think you sum up the situation very well when you say:
“Perhaps X suffers from more than schizophrenia or maybe has a discreet instinct to kill but I have no way of untangling X's mental turmoil and neatly categorising the various facets
Obviously, each of us can only write from our own experiences, and if your only experience of Schizophrenia is with a violent person then you would understandably conclude that this is a part of the persons illness (which it may be) and that all those with the same diagnosis must be the same. I know of another lady whose husband was always nasty to her, and so she concluded that this must have been because of his illness and that all people with Schizophrenia must be nasty, which obviously isn’t true. Some people are just nasty, and they may or may not suffer from mental illness as well.

I appreciate your point that you have been left damaged by this experience. (I didn’t want to say “I understand” because I don’t – I can’t imagine how traumatic the situation must have been for you) I hope you don’t feel unwelcome here simply because your experience has been a different one to my own. Your comments are valued as much as anyone else’s, and reading your experiences will give readers a broader view of how Schizophrenia can affect people.

Thank you for your response.

Tainted Holo, I have no objection at all to you responding to the previous comment. Thank you for your input.

Hi there Maxima, I’m sorry that you also have been a victim of violence. From what you describe it sounds as if your husbands attack was based on paranoia and delusional beliefs at the time, that you were being unfaithful to him. If he is not usually violent towards you then I would say you have no reason to worry while he is stable, but obviously, now that you know that violence is a possibility you may want to be more vigilant in looking for early signs of relapse.

I would also suggest that maybe you could talk to him about this incident and tell him that although he was unwell at the time, this sort of violence towards you is not acceptable. I say this because although his actions were related to his paranoia, they were based on feelings of jealousy, not a need to protect himself. If he was acting out of fear, I would say that is possibly harder to control, but since it was jealously, he had no need to harm you.

Although when very unwell a psychotic person may find it difficult to reason over what is right and wrong, it is not impossible. As Mr Ian said previously, many retain their moral reasoning. Mr Man has managed to resist harming himself because he knows it will upset me, so I think your husband could make to effort to restrain from trying to kill you.

I hope this helps.

Thank you to everyone for your comments.

Mr Ian said...

This post could go on a while (meaning, I could go on for a while about the topic of this post), so I'll stop here now and probably put something along these lines out on mental's site to open further discussions; particularly in recognition of your comment: "So really, all we can say is that everyone has the capability of being violent, mentally ill or not". - Absolutely.

BTW: I'm the 'tainted' one also - my partner's blog handle, by mistake. Sorry for any misperceptions.

Mr Mans Wife said...

Ah I see, it makes much more sense now, thank you for clearing that up.

Taking this topic over to Mental Nurse is a good idea; there are probably more readers there than here, and they love a discussion there don't they? :o)

About time I posted something else... now where did I leave my brain...?

Anonymous Mom said...

very interesting post and discussion here - thank you.

Anonymous said...

You should try to understand my absolute (and not unrealistic) anger against this illness
which is pure sensasionist crap
which is much fairer and more considered.
My my anger is real and not without reason, and perhaps may never leave me.
Which is why I post here, a kind of attempt to make any sense of it all.

Anonymous said...

Oh well none of the above links worked. So goto google and try "owen foster stab" which may give you a feeling for where my head is right now.


Joe Foster

Mr Ian said...

Joe, I managed to link to both articles and I indeed see where your head may be at right now.
The incident presents one of the extreme ends of the problems with mental health and is one of the reasons we have Mental Health Act's to detain people in treatment rather than in custody. It also allows for up to lifelong monitoring & treatment (the 'without limitation of time' part) which is necessary for people who present such risks.
The issues your case presents are in a great contrast to those that Mr Man presents; the only similarity is there is a diagnosis of schizophrenia involved which, in MMW's experiences, clearly demonstrates that psychoses in itself is not a guarantee of violence.
Whatever Tom's additional factors were at the time of his attack were sufficient to over-ride his own moral reasoning and, as I stated before, it would seem the majority of this was based in the intensity of his delusions.
Unfortunately, this does very little for you as a victim as you appear to already understand that the illness played a very significant part in this assault. I am sure you have many questions that are lacking answers - and possibly those answers are not forthcoming from the people you would expect to be able to deliver them. I will not begin to offer you any 'answers'; things seem far too current and you have every right to feel angry at this time. However, if I can offer any help to you in the future please do not hesitate to seek me out. I am happy for MMW to give you my email if you so request, and if MMW has no objections to doing so.

Kind regards


Mr Mans Wife said...

Joe, I also managed to read the articles (I just copied and pasted the address).

I am so sorry that your family has suffered in such a horrific way. I'm presuming that you are the original Anonymous? I obviously misunderstood some of your comments previously – when you said you had been stabbed over a prolonged period I thought you meant on many occasions rather than a prolonged attack.

Again, I misunderstood your comment about taking medication. I understand now that Tom’s medication had stopped for a while. Of course, once medication has been resumed it takes a while for it to get into the system again and to have its full effect.

Obviously, and understandably, you have been extremely traumatised by this experience, which has no doubt left you feeling a whole range of emotions. I understand that you hate this illness; I hate it too although no doubt for different reasons. Your hate is completely justified, as is mine, I feel. But we have to keep in mind that the illness is not the person. As Mr Ian has stated, Tom was obviously in the grips of very intense delusions at the time of the attack.

I’m curious to know who the scapegoats are that you mention. Although I don’t know you or your family I feel angry towards the hospital staff who allowed Tom to go without his medication. (Anti-psychotics can be injected if they cannot be taken orally) That anger is obviously based on my own experiences with Mr Man, as when he was in hospital with a psychical illness I couldn’t get the ward staff to understand the importance of him not missing even one dose. With Mr Man, as with many people with Schizophrenia, once he has missed some medication he loses insight into his illness very quickly and then doesn’t believe he needs the medication as he doesn’t believe he is ill. No doubt this is why Tom continued missing medication after his discharge.

Joe, I sincerely hope in time that you can come to terms with what has happened, and even rebuild your relationship with Tom. You are more than welcome to offload here if it helps you to make sense of what has happened.

Mr Ian, thank you for your response.

Thank you Anonymous Mom also – sorry, I have been a little “out of the loop” recently.

Cherie Braden said...

I am schizophrenic. I most definitely would never kill anyone. I am not subhuman. Even in my least lucid, most off-the-deep-end moments, my paranoia never tells me to strike out against others - it only tells me to hide, be afraid, and stay in my room where it might be safe. My illness is absolutely unconnected with whatever mechanism it is that prevents or urges people to kill.

I very much appreciate your championing this cause. Most people just have no idea.

Mr Mans Wife said...

Thank you for your comment Cherie, and welcome to my blog.

Mr Ian said...

An almost perfect post Cherie.
You are exactly right that the mechanism that prevents violence is not even the slightest bit related to the dysfunction of schizophrenia other than they both sit in the same head. The mechanism is generically termed as the threat-control override but there are many additional facets to it, including moral reasoning and willpower.

And I can agree to a point that many people who commit violence who also happen to have schizophrenia, do so due to personality and not illness. However, there are lots of confounders and interplays in this area that make it difficult to isolate one from another.

However, there are those with schizophrenia who commit violence acts because they have become overwhelmed by their delusions to such an extent they feel their life threatened. These are the people for who the Mental Health Act truly exists.
To label those who have this illness and, by virtue of their intense paranoid delusions or command hallucinations respond to perceived threats as in the latter scenario, to cast them into the category of 'subhuman' is unfair.

Mr Ian said...

Hi MMW and all,

I put something together on this topic on mentalnurse site that brings some of the theory together as discussed here.

Mr Mans Wife said...

Thank you for those links Mr Ian, I shall include them in the blog post.

Anonymous said...

Schizophrenia are likely to be violent than other members of the general population.Violence was associated with alcohol and substance abuse. Substance abuse raises the rate of violence in people with schizophrenia. It also occur in people who do not have any mental illness.

Dual Diagnosis
Dual Diagnosis

Mr Ian said...

You are wrong to suggest schizophrenia makes people more likely to be violent.
Substance abuse does - in people with or without schizophrenia.
As to does psychopathy or a violent upbringing.
Schizophrenia has very little bearing on when or if a person elects to become violent.

Mr Mans Wife said...

Thank you Sabina and Mr Ian for your valued comments.

To be honest I was slightly confused by your comment Sabina - I wasn't sure if you were saying that people with Schizophrenia are more likely to be violent due to substance abuse, because you end your comment by saying that others with no mental illness react the same way.

I agree with Mr Ian though; substance abuse can trigger violent behaviour in people with or without mental illness. Ask any policeman how many people they arrest for violent behaviour on a Saturday night, and how many turn out to have a mental illness.