The University of Texas at Austin
  • On mental health and violence

    By King Davis
    King Davis
    Published: Jan. 14, 2011

    Photo of King Davis

    Dr. King Davis, a professor in the School of Social Work. Photo: Tanya Hartman

    Dr. King Davis, the Robert Lee Sutherland Endowed Chair in Mental Health and Social Policy in the School of Social Work, served as executive director of the Hogg Foundation for Mental Health from 2003-2008. His current funded research focuses on the history of mental health services and policies for African American populations.

    An editorial in the Williamsburg Virginia Gazette in the 1760s commented briefly on the murder of an elderly woman by the son of one of her neighbors. The editorial writer described the young man as a lunatic and called on the Virginia legislature to protect the public from any future violence by building and maintaining asylums. The legislature created America’s first lunatic asylum at Williamsburg in 1775. The editorial also helped reinforce the publicly held assumption that mental illness is always associated with unpredictable danger and violence. This 18th century editorial has come to mind numerous times since the recent shootings in Arizona.

    A decision will be made soon whether Jared Loughner will share a severe mental illness diagnosis with Charles Whitman, John Hinckley Jr. and Seung-Hui Cho or the label of nihilist with the Oklahoma City bomber. As with these earlier episodes, the public reaction is understandably mixed. Throughout the nation, the personal expression of support and grief has been spiritually eloquent; and the incident served to bring Americans together as in 2001, albeit briefly. The other responses have been anger, confusion and a desire for retribution. The assailant has been described as a lunatic with calls for the death sentence, life without parole, or placement in a mental hospital. Gov. Jan Brewer of Arizona has issued a statement expressing her remorse. She understands these complicated issues from the standpoint of a parent of a severely mentally ill child. Her son was diagnosed with schizophrenia over 20 years ago and has lived in a state mental hospital after a not-guilty by reason of insanity defense. However, Brewer has been forced to cut state funding for mental health services.

    Most mental health professionals have reserved their judgment on whether Loughner is or is not severely mentally ill. These reservations may change as a detailed history develops, more observations are made, and a thorough forensic exam is completed. Most, however, are clear about the complexity of predicting violence and eschew the public assumption that historically connected it to mental illness. The mentally ill are usually not as violent as the rest of the population.

    There are other facts that we know about mental illness to consider. Mental illness is ubiquitous throughout the world. Fully 25 percent of the U.S. population has a diagnosable mental illness at any given time; but, only 5-10 percent requires intense professional care, according to the article “Twelve Month Use of Mental Health Services” in the Archives of General Psychiatry, a professional medical journal and a report by the Department of Health and Human Services. However, the majority of individuals with mental illnesses does not seek or accept help unless required by a court. Regrettably, unrecognized and untreated mental illness is common in the United States leading to major losses in productivity, absenteeism, academic achievement or healthy relationships. Families remain the primary caregivers and their lives, too, tend to reflect the emotional status of their loved ones. Since 2001, admissions to state mental hospitals have increased by 21 percent, reversing a 50-year decline, according to a 2009 article, “Changing Trends in State Psychiatric Hospital Use,” that briefly gave support to the idea that advancements in mental health sciences might result in their permanent closure.

    We also know that persons with severe mental illness tend to die 25 years earlier than others of the same age. Of these deaths, the majority are from preventable medical causes that have gone unrecognized and poorly treated. But up to 40 percent of these early deaths are from suicide. Admittedly, some individuals with mental illness may resort to violence when they believe that someone has done them harm as appears to have been the case at Virginia Tech. In addition, the person may expect to die in the commission of a crime almost as a martyr or as punishment. In his writing, Loughner appears to have predicted and planned his own death.

    So what are we to conclude? Mental illness is sometimes difficult to identify and sometimes even more difficult to treat or prevent. Predicting when or if violence will occur is more difficult. Clearly, little can be done where the illness is neither recognized or when professional help is not sought, rejected or unavailable. It is not clear whether Jared Loughner sought or used mental health care. However, we must not repeat the 18th century policy of locking people away in institutions. Rather, we must increase our understanding that mental illness is a brain disease that responds well to some interventions. We must increase public understanding of these illnesses and the value of seeking and using early treatment and the new services in the community and the campus geared towards integrated care and recovery.

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      Anon said on Sept. 20, 2011 at 1:03 a.m.
      As a consumer and a previous and future provider within the medical field, the public is too quick to link mental illness with negative aspects of the disease. The community stigma is perputated and self enforced within the client, by having the local Tx. MHMRs push sterotypes of lowered expectations, of behavior, employment, and education, onto its clients out of habit. The small town within Tx. at present is not ready nor willing to change its viewpoints, and is fully capable of using intrusive harrasment to provoke responces from clients they feel, upsets the status quo reflecting sterotypes. When are we going to hear from this University about the other consumers, the ones in the professional fields, the technical fields, etc.?
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      Qiran said on June 12, 2011 at 3:38 p.m.
      Undeniably imagine that which you said. Your favorite reason appeared to be on the internet the easiest thing to be aware of. I say to you, I certainly get irked while people feel about worries that they just don’t know about. You managed to hit the nail on the top and also defined out the whole issue without getting side-effects , people could get a signal. Will probably be again to get a lot more. Many thanks
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      Diane Taliaferro, LCSW said on March 13, 2011 at 6:40 p.m.
      Requesting Dr. Davis' speaking engagement calendar for the remainder of this year. Dr. Davis was one of my professors when I was a graduate student at Virginia Commonwealth Universtiy and I admire his work. Thank you.
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      Jude Pesin said on Feb. 24, 2011 at 1:20 p.m.
      MMm this is really cool, but i think that people needs more news about electric jellyfishes...
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      mary simms said on Feb. 7, 2011 at 12:49 p.m.
      My 8 year old son was diagnosed with "generalized anxiety disorder". After a couple tough years I realized his reactions were not getting better and had a full evaluation done on him. He was refered out for psycological services and after a year of realizing what we were dealing with and getting help he is doing very well. He just had his last appt. with his psycologist and his father and I are working hard to make changes in many areas not the least of which is parenting. Any how, meeting with teachers and talking with family and friends is frustrating. Folks tend to think we over reacted to his issues and that he would out grow everything or that, it is just his personality. Not living with him daily of course it was hard for them to know. There is judgement when he acted out, perhaps understandably, but also when we sought an evalutation, got a diagnosis and then sought psycological services. My son is a complicaed little guy and most people want to negate this. Often he is like other 8 year olds (he is a twin,has an older sibling too)) and other times he is quite difficult to fiqure out how to parent. I feel good about my choices to help him but also feel like I suffer a lot of judgement for it. Of course many people have been supportive but when things are difficult it is hard to tune out the negative feedback. Maybe more parents get discouraged about seeking help than you might think. Not to mention the process of figuring out the best chioces for your child it is absolutely overwhelming.
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      Kathleen K. said on Feb. 4, 2011 at 10:00 p.m.
      Responding to Mr. Kretchmar's comments above that "mental illness might be just poor behavior". This would be a generalization that just isn't true. Having worked with chronically mentally ill persons since 1999, I see the suffering that people diagnosed with schizophrenia and schizoaffective disorder undergo. Hearing voices in one's head is equivalent to turning on four different radio stations on at the same time, and some of them are calling your name, some are telling you that you need to die, that you are a bad person. More often I see self-deprecating hallucinations than having command hallucinations to hurt others. I cannot see how one has a choice in their behavior when they are beseiged by continual sounds and visual hallucinations, when what is real and what is not remains a mystery. While there are ocasional bouts of violence in this population, for the most part they are tortured souls, afraid to take medication because they think someone may be trying to poison them, or the voice of their "dead uncle" told them not to take the pills or bathe or shower or eat, because if they do, they will die. Mental illness is a painful disease that can be treated.
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      Elizabeth Johnson said on Feb. 4, 2011 at 6:05 p.m.
      Come to where I work and see the violent mentally every day of the week....to ignore the violent mentally ill as if they do not exist is to do an injustice to them and to those caregivers who put their lives on the line in taking care of them!
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      Tati said on Feb. 4, 2011 at 1:12 p.m.
      Thank you for the enlightening article and for helping raise awareness about mental illness. There is so much stigma around the issue.
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      callie said on Feb. 4, 2011 at 11:18 a.m.
      I have been hospitalized many times, about twice a semester. The stigma is just horrible. The first roommate I had my freshman year, whom I helped quite a bit in her mathematics, moved out because I was hospitalized. She told me that "it freaked her out and that she didn't want to be around a crazy person". That was one of the most horrible things I've ever heard in my life. Statements like that really hurt and most people will never know that. What's sad is that they probably know someone who has a mental illness but don't know it, because of the stigma.
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      R. Cross said on Feb. 4, 2011 at 5:01 a.m.
      Mental illness is the number one most treatable ailment, why must we hide from it and shut it away. I personally had to be treated for an ailment and am outraged that a person with a brain disorder be locked-up in the first place. The first step in solving any mental health issue is admitting to yourself you've got one and accept help usually in the form of a medication to resolve it. There are an array of advanced medications specific for a multitude of disorders. Why do we not utilize the years of research and development of these drugs and develop a better mental health system that works.
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      Kathryn Jennings said on Feb. 4, 2011 at 12:33 a.m.
      Mr. Krechmar, Schizoprhenia and bipolar disorder cause observable shrinking in parts of the brain, and patients typically display increased size of amygadala, etc. Regarding your statistic on schizophrenia becoming worse for those who are medicated, might it also be possible that those who are treated represent the patients with more severe manifestations?
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      Kathy said on Jan. 30, 2011 at 6:18 p.m.
      Why would a college be more liable than a grocery store clerk who recognizes that the person is unstable/a danger and kicks a person out of the store? What about the parents? And when is a person liable for their own actions? If it is when they reach a certain level of separation of reality, how would a college professor know this point? Just because a person used the same terminology, does not mean they then are responsible for that person's future actions. They are, however, responsible for making sure the other students are safe--which it sounds like they did. Even this is a monumentous task and a balancing act.
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      S. Randolph Kretchmar said on Jan. 28, 2011 at 2:11 p.m.
      "Mental illness is a brain disease..." is of course an omnipresent presumption, but scientifically unproven. Interestingly, recent research suggests that it tends to increase rather than ameliorate stigma. Medical students stigmatize mental illness more than the general population. World Health Organization studies show that what we call schizophrenia is something which usually occurs with young people, but which most often becomes a lifelong problem where it is treated with antipsychotic drugs, not where it is untreated. The dopamine hypothesis remains unconfirmed despite generations of intensive government financed research. This is not objective "brain disease" in any traditional medical sense. We merely want it to be brain disease, because that would enable us to hope that we're close to a "cure". But mental illness might just be poor behavior. That, after all, is exactly what enables it to be "diagnosed" - nothing more and nothing less.
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      Mike said on Jan. 27, 2011 at 11:54 a.m.
      The professor gave some good well thought out points. We don't want to lock up mentally ill people, unless they are a danger to themselves, or others. Mr. Loughner's college expelled him last May and was told "You will not be allowed to enroll again, until you show YOU ARE NOT A DANGER TO YOURSELF OR OTHERS." Some intervention sure should of occurred then. If it had maybe the tragedy in Tucson could have been avoided. The college knew about his issues, and did nothing.
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      B Solestis said on Jan. 27, 2011 at 9:52 a.m.
      That is one dramatic resume photo.
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      Brenda Matthews said on Jan. 22, 2011 at 11:25 a.m.
      I have medically treated depression and a son with schizophrenia. He is currently in a state hospital because his illness does not respond to current medications. He may always need hospitalization despite the availability of medications that help others. I am a liberal and despair over the budget cuts in states in the mental health arena. I believe most citizens, if educated on the issue, would not want these cuts. That is why I am open about my own illness in an attempt to remove stigma associated with mental illness. Someone "has" cancer, "is" not cancer...why do we label someone as "bipolar," when they have a bipolar condition. As a historian, I have hope, since we no longer use the term "lunatic," maybe in the near future, mental illness will be considered no more the fault of the individual than any other opportunistic infection or illness.
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      Abbie Rutledge said on Jan. 21, 2011 at 1:17 p.m.
      A very well written piece. And others' comments as well. Clearly we are all speaking to the choir here. But we must go on talking and enlightening because only through knowledge and education can we ever hope to change public opinion and thus public policy.
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      Yolanda C. Padilla said on Jan. 20, 2011 at 12:56 p.m.
      Thanks for this very important piece, King. The Arizona tragedy brings up very important issues. The lack of mental health care for adults in the U.S. is a crucial part of the equation which is often forgotten. It seems that people who are disabled by mental illness (or an emotional disturbance, as termed by the educational system) are protected through their school years by laws that require that all students receive an education regardless of a disability. As part of that, children receive services and are helped to reach their potential and to havea good quality of life. But the safety net disappears abruptly after school ends.
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      Lou C. said on Jan. 20, 2011 at 9:26 a.m.
      Aberrant, highly anti-social behavior tainted with hate comments and actions such as those of Jared Loughner, should be identified by those in contact with the person (school, friends) and reported to a "mental health" or 911 number. Our media needs to emphasize that this is a responsible action of a citizen and should be encouraged (as long as there will be follow up action). That's just the beginning. Some ideas . . the person in question should be visited by a mental health professional and an un-uniformed police officer to gather facts about the reported behaviors. If found to be a threat to "himself or others" as the present law states, or is disturbing the peace, a court appearance should be required. If the court, with mental health professional guidance, finds the person could present a danger to others, the name should be noted in a worldwide register as a "person of interest" and actions followed closely in the community. The person should also be offered, or mandated to have, a mental health examination with follow up therapy. Our present mental health laws are too lenient in trying to protect the misbehaving individual in question instead of protecting those who may be harmed by his actions in the future. Families in domestic violence situations are often unfortunate witnesses to this practice of "waiting" and people are killed even though repeated calls have been made to areas of "help" who did nothing because of having to wait until an act was committed. The "help" needs to become more active rather than passive. An individual cannot be made to change behaviors if they do not desire, but at least he can be given the opportunity and the community can be alerted to possible future problems. This is not labeling the person as "mentally ill" but as one with possibly dangerous, anti-social aberrant behaviors. Perhaps another category is needed to put some teeth into the law. We talk about all of this but we seldom do anything to change things so the outcome will be different. How many more times will we hear after a tragedy that a person who was a "loner" exhibited aberrant behaviors and people knew about it but either no one reported it or if reported, nothing was done about it.
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      Rhonna Robles said on Jan. 20, 2011 at 8:41 a.m.
      Having lost a son and brother to mental illness, I observed 1st hand the inadequit resources known and available. Not only does the individual with the illness suffer, but the entire family shifts their lives to accomadate the desease and accompanying behavior problems. This is a significant problem robbing the ill and their families of living and performing to their fullest. Both my son and brother were brilliant and talented, but did not function consistently in order to keep traditional careers. The loss to our society is immeasurable, but as other issues this is a complex situation needing thoughtful multi level solutions and today our society seems only capable of understanding issues that can be broken into black and white sound bites. Many solutions are required this is not a 1 size fits all fix.
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      Damian Crudele said on Jan. 14, 2011 at 9:31 p.m.
      mental health is something that varies from day to day for 100% of Americans. Violence is certainly not dependent on mental illness, it has a life of its own in these United States. Politics has a way of using mental illness as a shield for assassinations, lest we look into the possibility of someone having paid the assailant to do the killings for political purposes. Mental health is not really a science for the insane, it is the upkeep of our well being; choosing the best way to live our lives.
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      Who Is Mentally Ill? It’s Hard to Say – Wall Street Journal said on Jan. 14, 2011 at 8:03 p.m.
      [...] …Tucson renews call to remove stigma from mental health servicesSan Francisco Chronicle (blog)Opinion: Mental health and violenceUniversity of Texas at Austin NewsHow to Help Those With a Mental IllnessWHSVWashington Post [...]
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      Tweets that mention Opinion: Mental health and violence « Know -- Topsy.com said on Jan. 14, 2011 at 7:40 p.m.
      [...] This post was mentioned on Twitter by Jay Mills. Jay Mills said: Opinion: Mental health and violence http://bit.ly/gPKuJ4 [...]
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      Sharon McEachern said on Jan. 14, 2011 at 4:53 p.m.
      THE CLERGY AND OUR CHURCHES SHARE IN RESPONSIBILITY Mental health professionals tend to view the clergy as mental health gatekeepers because it is the clergy who are the most common source of help sought in times of psychological distress. But, sadly, many among of the clergy deny help to members of their churches when approached for guidance. According to one study, a whopping 32 to 40 percent of Christian ministers dismiss mental illness as a problem and tell church members that their problem is solely "spiritual in nature." Ethic Soup has a good post on this: http://www.ethicsoup.com/2008/10/demon-or-disorder-clergy-dismiss-mental-illness.html
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      ginny w. said on Jan. 14, 2011 at 4:53 p.m.
      The problem is that people who are acutely mentally ill do not know they are ill. Therefore will not seek treatment. The laws meant to protect people from family and friends seeking to "put them away" have in fact, kept ill people from getting treatment by making it almost impossible for any one else to make them get help, or even be involved in their care. We are killing people with the "privacy act". I am both in the medical field, and the mother of a mentally ill son.
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