Although there is growing awareness of mental health problems and increasing understanding of the mentally ill, fear still exists related to those who suffer from severe problems, particularly psychosis. Part of this is due to media coverage as they look to hook their audience with sensationalized stories so you don’t see headlines such as “Depressed Mom of 2 Sits on Couch all Day.” You also don’t see coverage of the vast majority of those suffering from psychosis since, “Well Medicated and Stable Young Man Returns to School, “ or “Woman Recounts Single Brief Episode of Psychosis from 10 Years Ago” likewise won’t be appearing any time soon in the newspaper or on your favorite internet news station. Hollywood often also portrays the mentally as a homicidal maniac in such films as Psycho, Misery, and Silence of the Lambs. But are most psychotic individuals really violent or is this is a myth created through fear and one sided media coverage?
The Basics of Psychosis and Schizophrenia
A psychotic episode is essentially the inability to tell reality from non-reality. Psychotic thoughts are often confused and distorted but depending on the type of psychosis they may also be well-organized and thematic despite still being delusional. People may also experience hallucinations or sensory experiences without any known sensory stimuli causing them such as hearing voices, seeing people, smelling or tasting things or the sensation of something on or under the skin which aren’t really there. Schizophrenia is the best known of the psychotic disorders but there are a number of others as well including brief psychosis and drug related psychosis and psychotic symptoms can be part of practically any other disorder including bipolar disorder, stress related disorders and extreme depression. Most people experience their first episode of psychosis in the teenage years or early twenties though this does not meant they will suffer from a lifetime of mental illness. One third of those who experience a psychotic episode never experience another and with early diagnosis and appropriate treatment and follow-up, most can manage their difficulties and live a productive normal life.
People with Psychosis are Violent - Truth or Myth?
According to research conducted by the Commonwealth of Australia, people with psychosis are not typically violent. In a large cohort study, less than 10% of psychotic patients sampled were violent. Those who were violent had specific characteristics. Most usually had a history of violence (before or after diagnosis), suffered from terrifying delusions or hallucinations or had a severe disorder which was self-medicated with drugs of alcohol.
What Really Leads to Violence in Psychosis?
Previously it was believed that violence in psychotic individuals was the result of paranoid ideation making the individual fear harm and strike out in perceived self- defense or to prevent harm. Recent studies have disproved this showing instead it is anger associated with delusions that leads to violence. When delusions included implied threat AND when this lead to anger (not anxiety, fear or depression) this was more likely to result in violence. Specific delusions that were identified as leading to minor violence included persecution, being spied on and conspiracy.
Conclusions
Most individual with psychosis are not violent. When they are it does not appear it is the disorganized and confused though process that is linked to violence but a small set of threat related delusions that leads to anger resulting in violence in some cases. In the absence of anger triggered by threat related delusions, violence is no more likely in individuals with psychosis than in the general population.
