Mental Illness Is Not a Political Football

I have previously written about the myth that those with mental illness are dangerous. Spoiler: they are not.

What is happening now politically is very concerning. Politicians are blaming mass shootings on mental illness and – as I cited before – Dr. Michael Stone, a forensic psychiatrist at Columbia University who maintains a database of 350 mass killers going back more than a century, has found that only one in five are psychotic or delusional. This means that 4 out of 5 mass murderers are people who are clinically sane.



Why do politicians blame mass murders on the mentally ill? Many agree with Fareed Zakaria that “turning immediately to the "sickness" of the shooter and piously calling for better mental-health care is, more often than not, an attempt to divert attention from the main issue: guns.”

This may well be true but it is damaging to label those with mental illness as dangerous to society. The prevalence of mental illness is difficult to nail down but “Around 1-in-7 people globally (11-18 percent) have one or more mental or substance use disorders. Globally, this means around one billion people in 2017 experienced one.”

This means that when we think of those with mental illness we should think of our family members, our partners, our children our friends and neighbours because that’s where you will find them. Or not find them because many hide their symptoms and suffering for fear of - you know - being labeled dangerous. That’ll certainly send someone into hiding.

Worse - mental illness is being used as an insult to those with political views we disagree with.


This is my tweet from this week:






The politician my tweet was directed at is not as important as the patients this politician’s tweet was directed at: those with mental illness have become the scapegoats of politicians.

Paraphrasing MLK gave me pause. However, his writings are filled with empathy for those suffering from discrimination and I thought that it might be appropriate to use this for this very maligned minority.

What I want to address is my dream: blaming and insulting (along with the unrealistic depictions in books and on screen) presents a very unrealistic portrait of those suffering from mental illness. After a long career of treating mental illness, I can describe them with some degree of confidence. They are just like you and your family, friends and children. They have the same wonderful qualities and the same vulnerabilities, the same bad jokes and the same hilarious ones. I could go on, but you get the picture.


I feel I must say this very loud for the people at the back: mental illness is a medical diagnosis no different than that for diabetes. It requires diagnosis and treatment and both should be given with care and compassion. Just like someone with diabetes or cancer - everyone with mental illness will have their own unique personalty but not the ones that politicians try to give them.

I was pondering - ok, I was fuming - about this issue the other day and thought about the origins of medicine. Originally all disease was thought to be in some way connected with the evil doings of those who are ill. So, diabetes, cancer and depression fell into the same category: “In prehistory, people believed that pain and disease originated from evil spirits. Disease resulted when these evil spirits entered the body. Witch doctors and shamans were employed to exorcise wicked beings…”

The belief that illness is caused by evil spirits taking residence in a patient changed when modern medicine discovered the actual etiology of physical illnesses. However, some still think that there is something evil in people who have mental illness.

Today many use the term ‘mental health’ “… to reduce the stigma surrounding mental illness, and said ‘illness’ reinforced prejudices against asylum patients because it implied segregation between the sick and the well. Focusing on health countered a persistent misconception that only some people are prone to psychiatric problems.”

This terminology is a double edged sword. Focusing on what is healthy in these patients is a good thing. However, there is value in identifying an illness. To tell a patient they have a physical illness is often a relief because they finally have an explanation for the symptoms from which they are suffering. They can explain this to those close to them, and get comfort and help when the symptoms flare up. The same applies to those with mental illness. I have found patients are immensely relieved to finally have a diagnosis and treatment plan. I have seen their relief when they can speak to those they love and get support in the same way those with physical illness get to lean on those in their life. 



 I’m comfortable with the term ‘mental illness’ and also happy to use the term ‘mental health’ if people prefer. What I want is to end the stigma, to treat each patient as just that: a person with an illness that can be be diagnosed and treated. The illness doesn’t define the person. Their character defines them.

Hell hath no fury...

Imagine being so ill that you cannot even get out of bed. Or being too sick to spend time with your family and friends. Now imagine being too frightened and ashamed to tell anyone you are ill. Being so humiliated by your disease, that you can’t even tell your own doctor that you are ill.

One out of five people, 20% worldwide, have a mental illness. Many often go through this scenario. Some bravely ask for help. Some hide in the shadows. Some hide in alcohol or drugs.

When I was a young, inexperienced doctor, I was certain that the unfair stigma of mental illness would and should be eradicated in my lifetime. I felt that mental and physical illness were both simply illnesses to be treated. Now, after treating mental illness for decades, I know that I was correct. 

The suffering of those with mental illness is real, and as varied, as patients suffering from anything from a broken leg to heart disease. Just as there is nothing shameful in having cancer, there is nothing shameful about having a mental illness.

Where I might have been a tad optimistic was in my hope that all the stigma of mental illness would be eradicated in my lifetime. However, since I am not dead yet there is, indeed, time. I have seen a lifting of the stigma of mental illness, a willingness to talk about it and reach out and get help. 

What we still need to do is reach into the dark corners, the places where this stigma grows, and open the curtains and let the light disinfect the place. 

The one prevailing myth that needs some attention is that the mentally ill are dangerous. This comes from articles about murders or violent crime, where mental illness is brought up as a possible cause. Also, from the books where murderers are often mentally ill: yes, I mean novels about crime.



If there is a disinfectant for myth, it is fact. 

Since the U.S. has one of the highest incarceration rates in the world, with 666 citizens in jail per 100,000 of the population, we can assume that most of the dangerous people do end up in jail. However, if all those who are mentally ill were dangerous, that would mean that 20% of the population, more like 20,000 per 100,000 population, would be in prison. 

How about an analysis of those who are in prison? Large scale reviews have shown that, in the prison population, less than 4% have psychotic illnesses. 

The myths of mental illness and murder arise most frequently with the worst offenders: mass murderers. Dr. Michael Stone, a forensic psychiatrist at Columbia University who maintains a database of 350 mass killers going back more than a century, has found that only one in five are psychotic or delusional. This means that 4 out of 5 mass murderers are people who are clinically sane. 

Even analyses of those who are mentally ill and commit crimes shows that only 7.5 percent were directly related to symptoms of mental illness. 

So, is there NO connection between mental illness and crime, particularly violent crime? The answer is that there is a very small connection, and one that is present largely in those who are not treated and who also abuse alcohol/drugs.

Those who are depressed are three times as likely to commit a violent crime. However, 60% of people who kill themselves have a mood disorder and suicide is the tenth leading cause of death in the US overall, and the second leading cause of death of 15- 34 year olds. Since there are twice as many suicides as homicides, the most likely violence done by depressed people is to themselves, not to others. 



With schizophrenia, the risk of committing a violent crime was 3-5 times greater, but this was found largely in those not on medication. This research on violence and mental illness also showed that those who are mentally ill are more likely to be victims of violence than perpetrators.

For a final look at mental illness and murder, I present the full quote from the title of this article: “Hell hath no fury like a woman scorned.” Most of us would say that scorn is a good motivation for murder and that Shakespeare was insightful for writing this. However, Shakespeare didn't write it -  it was written by the playwright William Congreve. Further, this isn’t even what was written - the actual line is ‘“Heaven has no rage like love to hatred turned / Nor hell a fury like a woman scorned.”

Common, widespread ideas can be wrong - like the origin of this “Shakespeare” phrase and the idea that those with mental illness are inherently violent. Certainty is meaningless unless it can be backed by facts, and in this case the facts do not support the certainty that most people feel.

Sometimes our first impression is wrong. Even with things we feel that we know, such as Shakespeare or mental illness.