As a disease and idea, schizophrenia has become linked with violent crime. In recent history, popular imagination has indicted the condition as a physical threat to society, and scorned those who suffer from the disorder without adequate treatment and understanding. Such a biased conception has principally derived from a confluence of criminal cases involving those with schizophrenia that captured the attention of mass media. In these cases – including the Slenderman stabbings and “Son of Sam” killings – schizophrenia has been condemned as the pernicious impulse behind extreme violence and thus misjudged as an inherently violent condition. , Despite a growing body of literature rejecting this view, this stigmatizing narrative of violence remains fixed in societal understanding. Even more troubling, this misperception of schizophrenia has obscured the far more pressing crisis of self-violence facing the schizophrenic community. As a destabilizing mental illness, schizophrenia has been shown to significantly increase risks of suicide and self-harm in its patients. To put in perspective: for every schizophrenic who commits a homicide, 100 will commit suicide. While claims of schizophrenic violence must be investigated and addressed, societal and medical investment must be shifted to meet the greater needs of at-risk schizophrenic patients. By reorienting this dialogue of schizophrenia around victimhood and self-harm, society can finally begin taking the necessary steps to improve the health and social treatment of this alienated community.
While schizophrenic violence warrants scholarly and societal attention, the issue has been overly narrowed and misunderstood to the detriment of those suffering from the condition. In common thought, schizophrenia has been blamed for unpredictably catalyzing a violent psychosis in its patients. To this end, schizophrenia has been believed to trigger violent tendencies that are unmanageable and inherent to the disorder’s genetic nature. Inevitably, this damning misinformation has informed a biased societal disposition to surveil and isolate the schizophrenic population rather than study and protect this forsaken patient group. In this way, scientific literature has historically focused on linking the disorder to violent proclivities instead of analyzing patients’ motivations for violent behavior and their experiences of victimhood. In fact, since 1990, there have been thirty-one studies concentrating on perpetrated violence within this mentally ill community and only ten concerned with its rates of victimhood. Thus, it is unsurprising that the narrative of schizophrenic violence has so trumped that of patient victimhood in common belief. However, lost in this misbalanced discourse is the harsh reality that persons with schizophrenia are up to fourteen times more likely to be the victim, rather than perpetrator, of violence in society. In this way, the implicit bias against schizophrenia in American academia and culture is rooted in a muddied and misguided narrative of harm. For greater context, this entrenched view of schizophrenic violence has been traditionally supported by a collection of outdated evidence that exaggerates patient rates of violence. While it is commonly stated that those with schizophrenia are four to six times more likely to commit a violent crime than the general population, recent literature has amended this number down and emphasized the inconclusiveness of oft-cited data sets. Indeed, a 2009 meta-analysis revised this average rate of violence to about two times with several stipulations, including the finding that no difference in violent crime exists when a patient does not engage in substance abuse. Overall, there still remain wide variations in these risk estimates as studies continue to be published, and society must not exaggerate the small amount of violence attributable to schizophrenic peoples. In all, perceptions of schizophrenic violence must change to reflect legitimate data from both analyses of violent victimhood and perpetration.
In addition to reorienting its framework on schizophrenic violence, society must take proactive clinical and social steps to ameliorate the problem that remains. Firstly, it is important to note that recent studies, including the cited one in 2009, have dispelled the myth that schizophrenia inherently raises one’s risk of becoming violent. Instead, literature has confirmed that patient outbursts largely arise from either treatable symptoms of the condition or environmentally-induced personal habits. Specifically, those more prone to violent behavior have been shown to experience higher frequencies of hallucinations and delusions, share less insight into their positive symptoms, and engage in substance abuse. In particular, patients with drug dependence have been found to commit violence at a rate of 27.6% versus 5.3% for the control population. Indeed, this problem of substance abuse represents the major contributor to the skew between rates of schizophrenic violence and those of non-affected persons in society. Nevertheless, this finding has meant that schizophrenic violence is in fact manageable and not categorically intrinsic to this disorder. In this way, many treatment methods have been made available to curb these motivating factors of violent behavior. Specifically, recent studies have found that regimented clinical treatment and therapeutic counseling can significantly reduce outbursts in a patient regardless of their socioeconomic background. Medically, a prescription regimen of second-generation antipsychotics that inhibits positive symptom experience – including clozapine, risperidone, and olanzapine – has been shown to significantly decrease violent episodes. Likewise, personal counseling and therapy have been highlighted as effective treatment methods in increasing patient insight into symptoms and reducing experiences of negative effects such as depression, mood variability, and isolative asociality. In all, the untreatable misconstruction of schizophrenic violence must be amended to enable more effective personal treatment programs for at-risk patients.
Aside from reorienting its approach to schizophrenic violence, society must substantially increase its investment in initiatives targeting schizophrenic self-harm. Given that discourse has heavily centered on violence perpetrated by schizophrenic patients, there has been a grave neglect of self-harm struggles facing this community. For scale, up to 40% of premature mortality among schizophrenics is attributable to suicide and unnatural death, and individuals with the condition lose an average of 28.5 years off the typical human lifespan. , Likewise, the lifetime suicide rate for schizophrenics ranges from 4.9% to 10%, which represents an 8.5-fold greater risk compared to that of the general population. , Importantly, many of the same clinical and social risk factors that underlie schizophrenic violence also serve as motivating drivers of self-harm. In this way, positive symptoms that contribute to suicide risk include fear of mental disintegration and increased levels of agitation and restlessness at the onset of symptoms. Likewise, nonadherence to antipsychotic treatment plans has been associated with a 12-fold increase in the relative risk of all-cause death and a worrying 37-fold increase in death by suicide. Behaviorally, substance abuse including alcohol consumption has represented a strong predisposing factor to higher suicide rates – a key similarity to the discourse on schizophrenic violence. It should be noted that research has found one notable difference in the causes of self-harm and perpetrated violence, namely that higher IQ, or levels of cognitive insight, has been associated with increased attempts of patient suicide, especially at the start of the condition. Such a finding iterates the importance of seeing and treating this broader issue of schizophrenic violence on an individual, case-by-case basis. All in all, the mounting body of literature on this topic has shown that greater resources must be directed to the same risk factors underlying schizophrenic violence and self-harm.
To effectively combat schizophrenic self-violence, deliberate action must be taken to provide early care to those most at-risk of not receiving proper treatment. Recent studies have shown that suicide risk is two times higher at the onset of psychotic illness than in its later course, with the highest likelihood of violent behavior in the first four years. As previously mentioned, this often arises from heightened levels of distress caused by new experiences of psychotic episodes. In this way, particular attention must be provided to patients in the initial stages of care to manage and prepare for the patient’s onset of symptoms. Similar to reducing schizophrenic violence, proper mental healthcare infrastructure must be augmented to reach all of those dealing with the condition. This is especially crucial in places with at-risk sociodemographic populations that may be already underserved by the healthcare system. This is to say, patients of schizophrenia that show the highest incidence of self-violence are young, male, single, unemployed, rural-based, and highly educated. Within American society, these demographics predominantly match those that have fewer infrastructural and therapeutic resources of support. On a related macro scale, only 31% of people with schizophrenia are ultimately treated in low- and middle-income countries, showing the global scale of this access problem. Nevertheless, this outreach strategy is particularly crucial since patients of schizophrenia often find themselves excluded from social environments where their behavior may be monitored outside of a clinical setting. Indeed, if the healthcare system is unable to reach these at-risk patients then schizophrenics are more likely to grow isolated and susceptible to the confluence of risk factors driving violent behavior. For context, the principal social factors underlying patient suicide risk include lack of stable and supportive relationships, social drift after the first episode experience, and social impairment. As such, ensuring that a patient has a positive medical presence throughout the course of the condition is necessary in case these risk factors materialize. This includes having a close medical oversight over a patient’s potential turn to drug use as a self-medicating coping mechanism. In all, efforts to curtail social and behavioral hazards align closely with those that manage the condition’s negative and positive symptoms – showing the feasibility and importance of implementing more widespread outreach strategies both nationally and internationally. Ultimately, taking these steps would substantially improve the mental state and societal place of this misunderstood and neglected community.
The narrative fabric of schizophrenic violence requires a new thread. In recent history, this highly stigmatized patient group has been misjudged as a helpless danger to society, and thus socially isolated from the general population. However, a growing body of medical literature has concluded that the condition’s violent risk factors are environmental and manageable under the right clinical and social supervision. Importantly, it has been found that the same set of effective treatments for mitigating schizophrenic violence also reduce incidence of self-harm – the gravest problem currently facing the schizophrenic community. To this end, necessary treatment programs must be expanded to serve all patients in all places, and society must carefully amend the narrative of violence it has embedded in the condition. Looking ahead, society must come to realize that these problems will only loom larger if they remain untreated. As the number of schizophrenic diagnoses continues to rise across the globe, ignorance is no longer an option. The time to take decisive action is now.