Tuscon shooter may be mentally ill – what does that mean?

Six people are dead and fourteen others injured by gunshot in Tuscon because of the actions of a man who may be mentally ill. Whenever something like this happens and the perpetrator is believed to be mentally ill, most of the general public accepts that as the full explanation. It’s really not, and there are a few things about this I’d like to clear up.

Mentally ill people are no more violent than other folks. Statistically, mentally ill people – even those with the specific illnesses most likely to cause violent behavior – do not actually engage in violence any more often than the general populace. For all the mentally ill people you hear about who commit acts of violence, there are tons more who don’t. Similarly, for all the neurotypical people you hear about who commit acts of violence, there are tons more who don’t.

Most mentally ill people make choices like non-mentally ill people. The vast majority of mentally ill people are fully capable of making choices. The only exceptions are those suffering from delusions, especially “command hallucinations.” Our minds tell us what is real. If your mind, compromised by a very specific mental issue, lies to you, you behave according to the reality your mind presents. If you’re bathing your children one day, and you realize quite clearly that Jesus wants you to drown them so they can be with him, then that’s what you do. To think you would never do that, that somehow you would overcome such a horrible command – that’s just not how delusions work.

But it must be emphasized that violence from delusions is incredibly rare. Most delusions don’t make a person feel the need to engage in violence, so even the vast majority of delusional people are as unlikely to engage in violence as the general populace.

If mental illness doesn’t cause bad behavior, what does? What causes bad behavior in people who aren’t mentally ill? Generally, it’s bad character: selfishness, lack of ethics, etc. Guess what? Being real, full-fledged humans like everyone else, mentally ill people can have character defects like anyone else. In the absence of command hallucinations, we must assume that people who do terrible things and are mentally ill did the terrible things because of their bad character, not their mental illness.

Drug abuse and growing up in a violent culture do make people more likely to be violent. This applies whether the person is mentally ill or not.

“Mentally ill” is an extremely broad umbrella term. The other problem in these discussions is that “mental illness” encompasses so many disorders which are extremely varied. Some are biochemical in origin, like bipolar disorder, schizophrenia and some cases of depression. They involve brain chemistry changes which are reasonably consistent from one patient to the next, and can be diagnosed through lab procedures, and should be thought of in similar ways to any other long-term illness. They are simple cases of physical issues.

But other mental illnesses, particularly the personality disorders, do not involve consistent physiological issues which can be diagnosed through lab procedures. They are defined by the patient engaging in behaviors that are particularly dysfunctional (even though most people with PDs are, in many ways, highly functional overall). These disorders were originally classified as character disorders, because it was believed they chose to live highly toxic lives. In recent years, psychiatry has reclassified them as personality disorders based on the idea that the personality is prevented from forming in the typical ways during childhood, and this results in a personality that is less adaptable than that of a non-PD person. While PDs cannot be treated, and people with them are notorious for being highly toxic to at least some of the people around them, are they really incapable of refraining from hurting people? This point is debated in psychiatry, but my answer is:

Not at all. Even serial rapists and killers – most of whom have PDs – make conscious choices all the time about who to attack, when to attack, how to attack, whether to insinuate themselves into the investigation, to engage in counter-forensics, etc. In most cases, the choices are all about avoiding capture (selfish motive). While there may be a degree of compulsion affecting many people with PDs, it is once again ultimately bad character that causes some of them to harm others. It must be remembered that even people who entirely lack conscience, and are therefore fully capable of doing horrible things without losing a wink of sleep, often choose not to harm or abuse people ever. Don’t go looking too hard for Dexter, the heroic sociopath who fights other sociopaths for you – but there are sociopaths leading quiet lives that don’t involve deliberate harming anyone ever.

So once again, the reasons why someone might commit a crime just don’t really include “because they’re crazy.”

Comments

  1. says

    Wow. Well written and powerful, a nice antidote to what’s to come because clearly, all those assholes who go on putting politicians into sniper’s sights and talking about armed insurrections and comparing Obama to Hitler and all that crap cannot, will not, must not take responsibility for being asses.

  2. Jennifer Kesler says

    The link on violence is in there now – I’m not sure how it didn’t get in there in the first place, but I was in a hurry to post. :)

    As for the psychology stuff… oh, boy. I’ve been studying it for 20 years, and my readers are at varying levels in their understanding of psychology in general, so it’s actually easier for you to just Google whatever you don’t understand. Otherwise I’d be linking every third word. Once you understand the clinical definitions and diagnostic criteria for these disorders, the rest is common sense.

    If you have specific questions, I’ll try to help.

  3. says

    It’s funny to me, sometimes.

    On one hand, I’m supposed to assume that all mentally ill individuals are nice and sweet and would never intend rudeness and should be forgiven all their sins because it’s just a misunderstanding the poor little dears bless their heart they meant well.

    On the other hand, I’m supposed to expect the mentally ill to randomly go nuts and act violently and that’s just what happens and it was only a matter of time and oh well what can you do other than lock them all up for their own good and isn’t that just so sad?

    :::headdesk:::

    Or maybe, just maybe, people are people, and anybody can be an asshole, mentally ill or not.

    Frankly, I don’t think there is such a thing as ‘mentally sound’. At least, I’ve yet to meet a single person who wasn’t some sort of crazy.

  4. Jennifer Kesler says

    Or maybe, just maybe, people are people, and anybody can be an asshole, mentally ill or not.

    Yep, that’s pretty much it! Sorry for those who wanted something complicated. :D

    Frankly, I don’t think there is such a thing as ‘mentally sound’. At least, I’ve yet to meet a single person who wasn’t some sort of crazy.

    Life calls for adaptability, and that’s inherently a little unstable. The only people who have the sort of stability we’re all taught to wish for are sociopaths, and it’s because they lack adaptability (and must therefore try to make life adapt to them instead of the other way around).

  5. says

    Sociopaths are a whole other kettle of crazy.

    But I wasn’t necessarily talking about stability. Everyone has something they are irrational or illogical about, something society as a whole would deem ‘abnormal’ on some level. Sometimes it’s good-crazy, like dancing around the house in your underwear because a good song is on the radio, sometimes it’s obsessive crazy, like spending 20% of your paycheck on trading cards, and sometimes it’s bad-crazy, like being an alcoholic.

  6. sbg says

    Sometimes I wonder if “mentally ill” is just a comfort blanket we all wrap ourselves in to prevent us from thinking any more about it.

    “Clearly this person had problems, that’s why it happened, we’re all fine, s/he was sick, we’re all fine, it’s okay, it’s okay.”

  7. says

    “Well, I have bipolar disorder, and I’m not coming to kill you. I promise.”
    –Journalist Andrea Ball of the Austin-American Statesman in response to the shootings

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