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More on Connecting the Dots Between Stigma and Mental Illness

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From “Stigma and Violence: Isn’t It Time to Connect the Dots?” (Schizophrenia Bulletin, June 7, 2011) by Dr. E. Fuller Torrey. The article is currently available to subscribers on the Bulletin’s website.

“As professionals who are theoretically trained to be aware of denial and other mental mechanisms for avoiding the truth, our profession has an unenviable record in our response to the problem of stigma. I will argue that solutions to this problem are obvious and can be achieved by connecting six dots.

Dot 1: Stigma against individuals with mental illnesses has increased over the past half century.” (Studies of public attitudes from 1950-1996 find that, despite increased understanding of what causes mental illness, stigma has increased.)

Dot 2: Violent acts committed by mentally ill person have increased over the past half century. (Studies carried out between 1900 and 1950 indicated that 1.7-3.6% of homicides were committed by “insane” or “psychotic” individuals. The most recent studies estimate the percentage is 10-17%.)

Dot 3: The perception of violent behavior by mentally ill persons is an important cause of stigma. It is clearly established that viewing mentally ill persons as dangerous leads to stigmatization….”

Dot 4: Most episodes of violence committed by mentally ill persons are associated with a failure to treat them. This has been demonstrated in many studies….”

Dot 5: Treating people with serious mental illnesses significantly decreases episodes of violence. Multiple studies have demonstrated that the treatment of individuals with serious mental illnesses with antipsychotic medication, especially clozapine, is effective in reducing arrests rates and violent behavior….”

Dot 6: Reducing violent behavior among individuals with mental illnesses will reduce stigma. This is the corollary of Dot 3. If violent behavior by mentally ill persons is an important cause of stigma, then reducing violent behavior should logically reduce the stigma….”

The article suggests two major reasons the dots do not get connected.

“The first is a reluctance to go to Dot 3, because it acknowledges that violent behavior among individuals with serious mental illnesses is a problem. That is politically incorrect. The mental health community reports like a mantra, 'mentally ill persons are not more violent than the general population,' despite overwhelming data to the contrary….

“The second reason why the dots do not get connected is because they lead to a politically incorrect end point….(In) order to ensure that seriously mentally ill individuals are receiving treatment so that they will not become violent, a subset of them will have to be treated involuntarily. Such treatment is regarded as an infringement on the person’s civil liberties and, as such, is politically incorrect.”

Dr. Torrey concludes that “The people who are hurt most by our failure to connect the dots are people with mental illnesses.” Until professional attitudes toward mental illness change, he says, they will continue to be hurt. Writing to fellow psychiatrists, he says,"It is as if we are experiencing a flood, but we professionals are fooling ourselves and averting our eyes from the source of the water. The public knows better. En route to work, they glance at the poster proclaiming that mentally ill people make good neighbors. Then they see the news about the latest violent act by an untreated person with mental illness. The public knows which one to believe."

 
 
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