Lovely write up, I often wonder about those who argue against the link between SMI-violence, specifically if they have had adequate exposure to state hospital or acute inpatient levels of care.
This was really enlightening. I shadowed (during the graveyard shift!) in the university hospital’s psych ED while in school for neuroscience; I thought I wanted to be a psychiatrist. The docs I shadowed were all deeply committed to their pts’ wellbeing and integrity, but also asked me to position myself differently when we had a pt in psychosis come in. I wasn’t to sit and needed to stand by the door.
Meanwhile, my neuroscientist and psychologist lecturers taught that pts in psychosis, and others w other sympx on the spectrum, were no more dangerous than any other person. I had a hard time believing it. Especially when one of the first pts I saw was a very large teen in the full throes of psychosis with spiritual themes. He’d been brought by the police after knocking his mother, who he was perceiving as an angel, clean out. I realized it was quite a quaint, privileged nicety the professors were teaching and the emergency psychiatrists were disproving.
Thanks for sharing this experience. While worth emphasising that most people who are acutely psychotic do not pose a threat to others - when aggression does occur it is often sadly the family who bear the brunt
As someone who has had the condition myself, I would agree with the author of this post that most people who are psychotic are not a danger to others, but (not a direct analogy, but just to provide a relatable example) in the same way that people who are drunk are not mostly dangerous, some of them can be, because they have lost control of themselves. This is a better way to view people in florid psychosis as it doesn’t paint these people as permanently flawed or evil. People do recover, and the causes of the condition are still not clear. The confusion in the media between psychosis and psychopathy is still a huge problem for people who suffer from psychosis, and it can fuel the illness. I avoided a formal diagnosis out of sheer luck and hiding symptoms until I stabilised on my own. Is this a good idea? No! But look at the alternatives. What would you do if you started to get paranoid?
We can believe that the homicide rate in schizophrenia is associated with the general population rate while still treating homicide by someone who is acutely psychotic differently, can’t we?
We can acknowledge that people with mental illnesses are more likely to be the victims of all crime while still accepting the specific risk of violence associated with inadequately treated schizophrenia.
Lovely write up, I often wonder about those who argue against the link between SMI-violence, specifically if they have had adequate exposure to state hospital or acute inpatient levels of care.
This was really enlightening. I shadowed (during the graveyard shift!) in the university hospital’s psych ED while in school for neuroscience; I thought I wanted to be a psychiatrist. The docs I shadowed were all deeply committed to their pts’ wellbeing and integrity, but also asked me to position myself differently when we had a pt in psychosis come in. I wasn’t to sit and needed to stand by the door.
Meanwhile, my neuroscientist and psychologist lecturers taught that pts in psychosis, and others w other sympx on the spectrum, were no more dangerous than any other person. I had a hard time believing it. Especially when one of the first pts I saw was a very large teen in the full throes of psychosis with spiritual themes. He’d been brought by the police after knocking his mother, who he was perceiving as an angel, clean out. I realized it was quite a quaint, privileged nicety the professors were teaching and the emergency psychiatrists were disproving.
Thanks for sharing this experience. While worth emphasising that most people who are acutely psychotic do not pose a threat to others - when aggression does occur it is often sadly the family who bear the brunt
As someone who has had the condition myself, I would agree with the author of this post that most people who are psychotic are not a danger to others, but (not a direct analogy, but just to provide a relatable example) in the same way that people who are drunk are not mostly dangerous, some of them can be, because they have lost control of themselves. This is a better way to view people in florid psychosis as it doesn’t paint these people as permanently flawed or evil. People do recover, and the causes of the condition are still not clear. The confusion in the media between psychosis and psychopathy is still a huge problem for people who suffer from psychosis, and it can fuel the illness. I avoided a formal diagnosis out of sheer luck and hiding symptoms until I stabilised on my own. Is this a good idea? No! But look at the alternatives. What would you do if you started to get paranoid?
As I said on X, This is whole approach is flawed! The rates of violence are substantially the same for SMI, compared to the gen pop: https://pubmed.ncbi.nlm.nih.gov/19457644/. Further, mental ill are significantly more likely to be vitims of all crime (and this is likely pathogenic) https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30002-5/fulltext
We can believe that the homicide rate in schizophrenia is associated with the general population rate while still treating homicide by someone who is acutely psychotic differently, can’t we?
We can acknowledge that people with mental illnesses are more likely to be the victims of all crime while still accepting the specific risk of violence associated with inadequately treated schizophrenia.
We can hold two ideas at once, right?