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Focus on mental health as cause of mass violence may be increasing stigma

For Immediate Release Oct 7, 2019

BLOOMINGTON, Ind. – In response to recent mass shootings and consistent public outcry, President Donald Trump’s administration is considering a controversial proposal to monitor people with mental illness in hopes of preventing mass shootings. But focusing on mental illness as the root cause for mass violence may do little to solve the problem. Instead, it will increase the American public’s stigmatization of people with these conditions, according to a new paper by IU Distinguished Professor of Sociology Bernice Pescosolido.

Bernice Pescosolido
Bernice Pescosolido.Photo by Eric Rudd, Indiana University

The paper, published in the October edition of the Health Affairs journal, examines trends in public perceptions of violence in people with mental illness and support for coerced treatment for these individuals across a 22-year period. The analysis found that not only had the perception of people with mental disorders as dangerous increased, the support for stripping these individuals’ civil rights also increased.

The National Stigma Studies, fielded in 1996, 2006 and 2018, were topical survey modules included in the General Social Survey, the longest-running monitor of attitudes, beliefs and behaviors in American society. In the survey, respondents were given one of three vignettes describing individuals who meet clinical criteria for schizophrenia, major depression or alcohol dependence, or a fourth non-clinical “daily troubles” vignette, without being labeled as such.

Respondents were asked to measure how likely the individual described was to do something violent toward others and how likely they were to do something harmful to themselves. They were also asked if they think the individual should be forced by law to get treatment from a doctor, take prescription medication to control their behavior or be admitted to a hospital.

In general, analyses showed an increase in perceived dangerousness over the 22-year period, especially in individuals with schizophrenia. Results in 2018 showed that:

  • 60 percent of Americans thought individuals with schizophrenia were likely to be dangerous to others.
  • 68 percent of Americans thought individuals with alcohol dependence were likely to be dangerous to others.
  • 30 percent of Americans thought individuals with major depression were likely to be dangerous to others.
  • 20 percent of Americans thought individuals with “daily troubles” were likely to be dangerous to others.

Pescosolido said these results are troubling because there is little evidence that supports the notion that individuals with mental illness are more likely to commit violence. In fact, she said those with mental illnesses are more likely to be victims of violence than to be perpetrators of it. Also particularly alarming to Pescosolido is the increase in perceptions of non-clinical “daily troubles” as dangerous.

A graphic about mental health stigma and mass violence
An accessible version of this graphic can be viewed online.Graphic by Samantha Thompson, Indiana University

She said these shifts likely reflect the hope that medicine can solve the problems of increasing violence in America.

“In a society that’s progressive, people hold medicine in very high esteem,” said Pescosolido, who is also director of the Indiana Consortium for Mental Health Services Research. “But this way of thinking presumes that psychiatry can identify people who have never been violent as potential mass shooters, when the best predictor of violence is past violence, and most people with mental illness don’t have violent pasts.”

Support for coercive hospitalization for people with schizophrenia, already high, increased more than 10 percent between 1996 and 2018. Increased support for coercive physician treatment and hospitalization was higher among recipients who assessed individuals’ potential dangerousness as more severe.

“There is a strong link between these perceptions of danger and the willingness to take away someone’s civil rights or their own ability to determine whether or not they need treatment,” Pescosolido said. “I believe that one way the American public tries to understand why someone did something heinous is to assume they must be ‘sick.’ But the majority of those who commit mass violence have not been documented to have a mental disorder.”

Even though there is a link between perceived violence in mentally ill people and a willingness to strip their civil rights, she said studies have also shown that perceived violence is not significantly linked to the support of increased government funding for mental health services.

But, according to Pescosolido, even if this were the case, the country does not have enough facilities or doctors to support a government plan that rests solely on psychiatry’s shoulders to solve the colossal issue of mass violence. While many doctors have rallied behind gun control and see mass violence as a public health crisis, she said they have not suggested returning to the mass confinement of people with mental health problems.

“I really hope we change the dialogue around issues of violence in our society and try to get at the root causes rather than the typical and seemingly easy answers that will not help us eliminate issues of mass violence,” Pescosolido said. “What is it about isolation in our society and culture or how we treat each other that makes people want to take out other people?”

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