ON MENTAL ILLNESS: Dr. Drew, Schizophrenia and Violence

By Jack Bragen
Thursday August 02, 2012 - 04:31:00 PM

Dr. Drew is a television psychiatrist who deals mainly with the issue of addiction, but he also comments on other aspects of psychiatry. On one of his programs, he tried to point out warning signs (of impending trouble) that people should look out for when dealing with persons with mental illness. 

There was a recent horrible shooting in Aurora Colorado at a movie theater. Part of my comment stems from Dr. Drew's coverage of this. 

I like Dr. Drew and his TV shows. However, I think his portrayal of mentally ill persons as frequently dangerous people requires a response. I believe Dr. Drew's picture of persons with mental illness is a bit skewed. Most people with mental illness aren't violent. 

I won't lie to you and say that persons with mental illness never get violent. I have dealt with mentally ill persons getting violent toward me. I have also dealt with the violence of criminals, which is a more organized and more sinister type of violence, which is not a symptom of mental illness, and in which the perpetrator is completely responsible. 

Concerning the recent massacre in a movie theater; the apparent perpetrator seemed to know what he was doing, which is a trait unlike that of a de-compensated person with schizophrenia. However, one point of this article is to tell the reader what to look for to know that a person with mental illness is essentially healthy and is not controlled by the illness. 

The biggest thing to look for is the healthy expression of emotions. Anger is included in this, but only when the anger is expressed verbally and doesn't involve an episode of physical violence. Sadness at a loss, grief, and the ability to cry and express sorrow are signs of health. The ability to complain when things are difficult might be unpopular with people who don't want to hear complaining, but it is a healthy trait and means that a person is "engaged" in their environment, and isn't stuffing his or her feelings. 

Constructive behavior is another sign of health. This entails taking actions, preferably in an organized manner, toward achieving a "positive" goal. This could include looking for a job, school, or volunteer work. Or it could include attempts at starting one's own business. It does not include lottery tickets, or plans to run for political office. 

The history of the movie theater perpetrator included not communicating with peers or school counselors. This lack of a connection with people, the lack of even a derisive connection, was a sign of trouble. The movie theater perpetrator never seemed to express any emotions, and that was another warning sign. Some of these signs I am talking about can predict the difference between a person with mental illness who is capable of receiving help, versus someone who is overly disconnected and who can't be helped. 

Asking for help is nearly always a good sign. Being able to listen to others and to change one's thinking or one's stance is a sign of flexibility, and that is good. Being able to admit having a flaw and admitting one's mistakes are signs of health. 

An insanity plea doesn't work when someone has made organized plans to carry out a crime, or when their actions reflect premeditation. The actions of the person who did the shooting in the movie theater reflect forethought and an organized plan. This is not a case of a mentally ill person becoming violent. It appears to be a situation of hate carried out in an organized and methodical manner. 

In contrast, a person with schizophrenia having an episode of psychosis would have been disorganized and disoriented. Such a person could become violent in a disorganized manner if their delusions, or the despair of being ill too long, led to that. Schizophrenia impairs someone to the extent that he or she can not reason things out. Thus, an organized plan of the type we saw in the theater precludes severe psychosis. And it also implies the possibility of a personality disorder such as sociopathy. 

It is possible to have schizophrenia and to be "emotionally healthy," since it is a medical condition. And when under treatment, and the medication has restored normal functioning, it does not preclude the person having normal and healthy emotions. Mental illnesses which are caused by brain disorders do not automatically make a person have an unhealthy personality, since there are people with schizophrenia who compensate for their "hardware problems."