Theroux approaches the subject matter with his known warmth, finding humour where he can. In doing so he raises important questions about the incarceration of people with mental health problems and the impact of potential over medicalisation. But he also by default reinforces the stereotype that people with schizophrenia are dangerous.

I don’t believe in censorship. There is clearly space for such documentaries, and albeit less clearly films like The Voices – but there also needs to be a reality check: a recent study of more than 40 films released between 1990 and 2010 found that over 80% of main characters with a diagnosis of schizophrenia displayed violent behaviour and nearly a third engaged in homicidal behaviour. Let’s put this in context, schizophrenia may not be regarded as a common diagnosis, but there are approximately 220,000 of us in the UK living with it; if a third of us really were killers, that’s a body count Quentin Tarantino would be proud of.

http://www.theguardian.com/healthcare-network/2015/mar/27/schizophrenia-portrayed-negatively-the-voices-louis-theroux?CMP=share_btn_fb

I think if I were schizophrenic I'd do better to keep my diagnosis to myself. Too much negative stereotyping to risk exposure.

Here're the BBC iPlayer links to the two part Louis Theroux documentary the article references.

By Reason of Insanity Part 1
By Reason of Insanity Part 2

In Out of the Shadows, published by John Wiley & Sons earlier this year, I estimated that there are now approximately 1000 homicides a year committed by individuals with schizophrenia and bipolar disorder, almost all of whom were not taking medication at the time of the homicide. My estimate was based on all cases in a metropolitan area of 4 million people for 1 year, then extrapolated to the whole country. Anecdotal evidence suggests that such cases are not unique to urban areas so I think such extrapolation is reasonable. To date, nobody has challenged this 1000/year estimate. Altogether in the US there are approximately 24,000 homicides a year.

Dr. E. Fuller Torrey

http://schizophrenia.com/family/viol.htm#predictors

The Prevalance Rate for schizophrenia is approximately 1.1% of the population over the age of 18

http://www.schizophrenia.com/szfacts.htm#

So in the usa there are 250,000,000 people and 1000 homicides commited by people with schizophrenia (invariably unmedicated at the time of the incident). I think that means that with an annual homicide rate of 24,000 that people with untreated schizophrenia are approximately 4 times more likely to commit a homicide than a healthy person. The glaring issue to me seems to be that:

a) this figure is lower than the media would seem to imply (you never hear about benign schizophrenics).
b) the figure for homicides committed by medicated schizophrenics is surely much much lower - maybe even below the national average. I can't find the figures for this however.

Dr. E. Fuller Torrey - a well known researcher, psychiatrist and author in this field, - From his recently published book "Out of the Shadows - Confronting America's Mental Illness Crisis"

http://schizophrenia.com/family/viol.htm#predictors

This book includes further details of the study which found the 1000 schizophrenic homocides per year in the USA figure. I'm looking for it on amazon as hopefully it would include the crucial detail of the number of homicides committed by schizophrenics receiving treatment. That could be part of the answer to the negative stigma if it is as low a figure as the snippit suggests.


ETA: OK so I've ordered the book but I'll have to wait for it to arrive from the US.

If the number inferred for the whole country is 1000, and the sample size is 4 million, then it's fair to say the number of schizophrenic homicides observed was around 15. "Almost all" of 15 is around 12. So in truth, the likelihood that a schizophrenic receiving treatment would commit a homicide is actually significantly less than for the general population. The stigma seems completely unjustified, given that the vast majority of diagnosed schizophrenics are receiving treatment. Stupid fucking planet.

Perhaps if everybody took anti-psychotics there would be fewer homicides...

I've sometimes wondered if there is an agreement between the movie industry and mental health. They get mental health issues so wrong that it certainly makes for entertaining performances when assessing a non schizophrenic who is claiming to be not criminally responsible. Johnny Depp would be proud of some of the performances.

In terms of this research you posted, I would have to look into it further. I don't work with adults with acute psychosis anymore, so I'm not as up on this area in the research. What I do remember is that when I worked with this population, people with schizophrenia on average were not more violent than the general population. That is probably based on combining treated and untreated as one cohort.

Keep It Real wrote:

In Out of the Shadows, published by John Wiley & Sons earlier this year, I estimated that there are now approximately 1000 homicides a year committed by individuals with schizophrenia and bipolar disorder, almost all of whom were not taking medication at the time of the homicide. My estimate was based on all cases in a metropolitan area of 4 million people for 1 year, then extrapolated to the whole country. Anecdotal evidence suggests that such cases are not unique to urban areas so I think such extrapolation is reasonable. To date, nobody has challenged this 1000/year estimate. Altogether in the US there are approximately 24,000 homicides a year.

Dr. E. Fuller Torrey

http://schizophrenia.com/family/viol.htm#predictors

The Prevalance Rate for schizophrenia is approximately 1.1% of the population over the age of 18

http://www.schizophrenia.com/szfacts.htm#

So in the usa there are 250,000,000 people and 1000 homicides commited by people with schizophrenia (invariably unmedicated at the time of the incident). I think that means that with an annual homicide rate of 24,000 that people with untreated schizophrenia are approximately 4 times more likely to commit a homicide than a healthy person. The glaring issue to me seems to be that:

a) this figure is lower than the media would seem to imply (you never hear about benign schizophrenics).
b) the figure for homicides committed by medicated schizophrenics is surely much much lower - maybe even below the national average. I can't find the figures for this however.

I reread this, and the extrapolation is flawed, acuity increases as one gets closer to the inner city, and generally decreases as you go more rural. On the other hand, extreme isolation in rural areas decreases service availability, but population density is much lower.

Willie71 wrote:

I reread this, and the extrapolation is flawed, acuity increases as one gets closer to the inner city, and generally decreases as you go more rural. On the other hand, extreme isolation in rural areas decreases service availability, but population density is much lower.

So my extrapolation that treated schizophrenics are less likely than your average Joe to commit homicide is true to an even greater degree, if anything. It's difficult to classify myself as a schizophrenic because the medication I take obviates any positive symptoms. Nevertheless, I find myself reluctant to admit my diagnosis to, well, anybody, because of the negative stigma.

I remember a comment from crazyfitter where he called me crazy; that watching people on the apprentice makes me feel better about myself. so I guess that prejudice exists here too.

Keep It Real wrote:

Willie71 wrote:

I reread this, and the extrapolation is flawed, acuity increases as one gets closer to the inner city, and generally decreases as you go more rural. On the other hand, extreme isolation in rural areas decreases service availability, but population density is much lower.

So my extrapolation that treated schizophrenics are less likely than your average Joe to commit homicide is true to an even greater degree, if anything. It's difficult to classify myself as a schizophrenic because the medication I take obviates any positive symptoms. Nevertheless, I find myself reluctant to admit my diagnosis to, well, anybody, because of the negative stigma.

Yes, you are correct. When treated, people with schizophrenia are usually quite docile. The treatment manages positive symptoms really well, but the negative symptoms of flattened or blunted affect, social withdrawl, and the prevalence of marijuanna use results in pretty meek people. This is grossly overgeneralized, but overall, violence when accepting treatment is not common,

It doesn't so much matter if the diagnosis is accepted, as long as you can be aware that your life is easier when accepting treatment, and it sounds like life is pretty good right now. We focus a bit too much on labels, and not enough on functioning.

Keep It Real wrote:Perhaps if everybody took anti-psychotics there would be fewer homicides...

That's probably true. It's an interesting statement, and similar to statements I've heard from schizophrenics, where it's something that is often called "schizophrenic insight." It's the kind of thing that I think, too. Now I've never been diagnosed as schizophrenic (but what of it?) Looking into schizophrenia and the way I think, which is often similar, I think that schizophrenia relates to a different-from-ordinary construction of categories as the basis of cognition using framing and metaphorical thought.

I'll start with an example. There is no such thing as an anti-psychotic in reality. There are chemicals, and we can understand these things well enough, perhaps. They have effects on bodies, including the brain, which is part of the body. It's a bit harder to get this right, because one has to look very, very carefully, and there is the problem that bodies can be very different one to the next. But maybe there's some approximate understanding of what we do. And then there's a condition that we'll call "psychosis" and "schizophrenia," which is, empirically, pretty much just a set of behaviors, which according to some standard, we have decided to call "bad." And we decide, perhaps, that this particular molecule is "good" "for" "psychosis," and so we call it an "anti-psychotic."

That's verbal shorthand, and it's probably useful, though it kind of disguises the fact that in there are half a dozen or more pretty blithe assumptions, any of which could be full of shit. I'm sure that the verbal shorthand is appealing to morons who cannot keep enough concepts in mind at once to think about a system, and unfortunately, the overwhelming majority of people appear to be morons.

But we know, for example, that Splenda, the very safest artificial sweetener, and Warfarin, which is useful for preventing blood clots, came out of rat poison research. I'm pretty sure if the natural food weenies found out that Spenda was intended as rat poison, they'd have a field day with it and convince everyone to use organic sugar beets with so many natural pyrethrins from chrysanthemums on them that they'll put you into anaphylactic shock at fifty meters.

So let's drill down to the "anti-psychotic" as one of a set of chemicals. I was, as I mentioned, never diagnosed as schizophrenic, but I was prescribed "anti-psychotics," specifically trifluoperazine, brand name Stelazine, which is of a class of drugs known as phenothiazines. All these are funny words, but at least they don't make the blithe mythological assumptions that "anti-psychotic" does. They are commonly used to treat psychosis, anxiety, and nausea due to chemotherapy.

So I was prescribed some of this, but not for psychosis. I had presented for what people call "depression." That is, I'd been miserable for a long time, since age 10 or so. It wasn't the first time, but all those other times I was put into that shit they used to do during the 1970s, which they called therapy, counseling, and don't get me started on Transactional Analysis. But I was in college, and I had vaguely heard that there were mythologically named "anti-depressant" drugs, and I wanted to try some and see if they did anything.

I was prescribed Stelazine. Let's just deal with the chemical effects. It turned me into a zombie. It was like those Haitian coups, which turn people into zombies. Sometimes they get buried as part of the zombification. They're not actually dead, of course, just significantly impaired. And the Haitians call these things coups, or "spells" approximately, instead of drugs, poisons, or chemicals, another example of mythological thinking.

I'm going to mention this, because I think it is informative of how psychiatry is done. It took me some time to figure out why I was prescribed Stelazine. I learned much later that there is a belief in psychiatry that such drugs can help depression, but that is of a character too general to be of much use to me. During a follow-up, he said something that I considered a lot. He said, "you can't let yourself get so angry." Well, I wasn't angry. I was frustrated, of course, because I wanted some relief, and I didn't get it, even though I was doing all the things that are supposed to work. But not angry. I have a rather sharp tongue, but physically, I detest violence, even to the point of having a really hard time doing it when someone is being violent toward me. I don't see any problem with words, because I'm a skeptic, and so I think the best way to test an idea is to be extremely hostile toward it and see if it survived.

But later, though another pathway, a kind of activism that I have since learned almost all liberals consider vile and worth nothing, though the people who were doing it were genuinely liberal, I found out about the Conyers and Conyers study, "Sex Differences: A Study in the Eye of the Beholder." I've written at length about it before with seemingly not much effect, so I'll only touch on it briefly. Adults were asked to judge the emotions felt by an infant. When told the infant was a boy, they guessed "anger," and when told it was a girl, they guessed "fear." This behavior appeared to be universal; people who thought themselves anti-sexists did it just as consistently and intensely as traditionalists do.

So, of course, he was going to interpret me as angry; that's all that made sense for him. That's the only way he could conceptualize what I was saying. I understand cognition a lot better now, but at least I had a handle on it then. I am a large male primate. At six feet, I'm not exceptionally tall. With a 47 inch chest, I'm not exceptionally bulky. But I just give the appearance of being big, and I am male, so I am therefore a threat. What do you do with people you consider threats? Well, you try to disable the threat. You essentially castrate them. (Note that I personally do not think in terms of "castration" as a metaphor, as I don't associate being male with being a threat. But the overwhelming majority of people, including psychiatrists, do.)

My best friend and colleague sat me down and told me that I wasn't me, so I stopped taking the drugs AMA. That didn't fix anything, but it didn't worsen anything. I do know that those drugs pretty much kill any violent impulses, but they also kill the impulses of basic strength that are necessary simply to live. I should note at this time that the first Nobel Prize in psychiatry was given to the discoverer of the lobotomy, which was sold not on the idea that it helped anybody but rather on the idea that it made them docile and easier to take care of.

For some time, based on some things later from a wife who was a psych nurse, I wondered whether psychiatrists had a stronger contract with society than they did with patients. I have since abandoned this. I now think that their primary contract is with themselves. As long as a "treatment" satisfies their psychological beliefs and needs, whether it actually helps the patient is unimportant. I have a lot of other evidence for that, but this answer is going to be very long already.

Anyway, I stopped, but also, my experience with psychiatrists caused me not to seek treatment until I was about 33. When I did seek treatment, it was because I had gotten enough better in life. My career, at least, had been going well, and I had some things I could be extremely proud of. Still, I had these serious depressions once every three weeks. Curiously, they synchronized to the menstrual cycle of a woman I had been living with. I presented for treatment and was diagnosed as bipolar. This had some unpleasant secondary effects, as it prevented me from getting individual health insurance at any cost. I was doing consulting and could have afforded it, but nobody would sell me any. Then I got sick with three bouts of pancreatitis, leading eventually to a cholycystectomy, insulin-dependent diabetes, and later a pancreatic cyst that closed of my stomach and made me lose a lot of muscle mass, so that I could hardly walk without collapsing. My legs grew back, but the acid reflux during that time ruined my teeth. I managed to get the two worst ones extracted surgically yesterday, but I have 15 more teeth and some dentures to go before I can even reasonably expect to be able to show up at an interview with my face looking as it is. The total health problems ran to hundreds of thousands of dollars, and, though I couldn't pay them all, what I did pay wiped me out. That process started about 10 years ago, and I have yet to recover.

However, some of the drugs I was prescribed did work. Mostly Buspar, Neurontin, and some benzodiazepines. I took some SSRIs, but they didn't help. I knew that the drugs weren't guaranteed to work forever, though the psychiatrists told me that I'd have to take them for the rest of my life. So I did other things to help myself, including various cognitive therapies and some I invented myself.

That worked, though it took about three years. I kept some of the bipolar "superpowers," such as being able to stay up for three days at a time, which can be quite useful. But I am no longer hurt by them.

Other people have noticed the transformation. My now deceased mother, for one. Of course, most of her reaction was to go back to trying to do the things that had lead to my depression since about age 10. They worked very well, then, but I was strong enough that it seemed to me ridiculous to try it on an adult. But very rarely, she was impressed. She expressed the idea that it would be wonderful if someone would study me and what I did and use the information to help others. I just laughed and said, "nobody is interested." Which they aren't. When I describe these things, people tell me it's impossible, and that I'm lying, and that I must never really have been depressed. It gets pretty abusive. But now I understand cognition better, and I understand why they do this. It is part and parcel of what is done in psychiatry all the time.

So people talk about this "stigma," but it's only an occasional reaction. And then they try to find something to "blame." Movies. "Society." Ignorant people. But no; this is the primary and overwhelming process of psychiatry, done for pure, enlightened self interest. The purpose is to generate and maintain a class of people that, by universal agreement, who can be pathologized, feared, and therefore hated. That is the point. By becoming a psychiatrist or being liberal, one can gain a higher moralistic self-image. It doesn't apply to everybody, of course. Some people are genuinely motivated to help people and fix problems, and a small but important subset have the talent to do this. The psychiatrists I've known who could had the honesty to admit that they didn't really know how they did it. Now, with my better understanding of cognition, this seems natural to me, as it involves brain processes that do not map onto the folk model of rationalism and reason. But also, the few people who do this know that they are completely outnumbered. This gives me a cognitive advantage; when people reflexively defend psychiatry, I know that they are part of the problem and will always be. This saves me a lot of effort trying to explain things to them. It's not that they are that stupid, though they're pretty stupid. It's that they are categorically hostile to the idea that it isn't all Nu-Perfect. Plus, I understand the cognitive processes behind that as well.

I have witnessed the dehumanizing of psychiatric clients myself too. Having ADHD, Bipolar II, and SAD, I know how frustrating accessing treatment can be. Some of us actually see our clients as people with lives, families, and friends, but many only see an illness. I absolutely hate it when a client says their treatment isn't working, but the "team" tells people to stay on the treatment or they will get sick. WTF??? The person acknowledges being sick, and wants a change to get better. Too many people practise with 10 to 30 year old information. This shouldn't happen anymore.

That's a very interesting post epepke. I might dive into it at length but there was something in your conclusion I'd like to sddress first:

epepke wrote:So people talk about this "stigma," but it's only an occasional reaction. And then they try to find something to "blame." Movies. "Society." Ignorant people. But no; this is the primary and overwhelming process of psychiatry, done for pure, enlightened self interest. The purpose is to generate and maintain a class of people that, by universal agreement, who can be pathologized, feared, and therefore hated. That is the point. By becoming a psychiatrist or being liberal, one can gain a higher moralistic self-image.

I encounter negative stigma about schizophrenia about 50% of the time I mention it to strangers, and who knows the thoughts of those who show no outward sign of stigmatising the illness. It's not only an occasional reaction IMHO. Your bleak prognosis on the motivations behind psychiatry don't tango with my experience. I bet 99% of psychiatrists would outright cure all mental illness if they could and some seem engaged in efforts to lessen stigma suffered by those with mental illness. Perhaps not as many as there should be but still, some.

The stigma associated with schizophrenia is unlike that of other mental illnesses IMHO - largely because of media portrayals of schizophrenia. I remember when asked why I was "on the sick" by a young lass I told her my diagnosis and she said "Oh, so are you going to kill us all then?" People often conflate schizophrenia with psychopathy too, in my experience. I don't think ADHD has the same baggage, for example.

Sounds to me like the young lass was just your average ignorant person. It happens over pretty much anything - I used to be a librarian, and when I told people, their usual response was 'so you sit and stamp books all day?' In reality, librarians don't tend to stamp books at all (library assistants do that) - they are cataloguing, classifying, conserving, purchasing, budgeting, advertising, liaising, etc etc etc. I've also had to explain to several people that yes I'm an atheist but no, I don't believe that God does not exist. Sadly most people are simply astoundingly ignorant about anything which occurs just outside of their tiny sphere of knowledge and have overly simplistic or flat out erroneous views as a result.

Keep It Real wrote:That's a very interesting post epepke. I might dive into it at length but there was something in your conclusion I'd like to sddress first:

epepke wrote:So people talk about this "stigma," but it's only an occasional reaction. And then they try to find something to "blame." Movies. "Society." Ignorant people. But no; this is the primary and overwhelming process of psychiatry, done for pure, enlightened self interest. The purpose is to generate and maintain a class of people that, by universal agreement, who can be pathologized, feared, and therefore hated. That is the point. By becoming a psychiatrist or being liberal, one can gain a higher moralistic self-image.

I encounter negative stigma about schizophrenia about 50% of the time I mention it to strangers, and who knows the thoughts of those who show no outward sign of stigmatising the illness. It's not only an occasional reaction IMHO. Your bleak prognosis on the motivations behind psychiatry don't tango with my experience. I bet 99% of psychiatrists would outright cure all mental illness if they could and some seem engaged in efforts to lessen stigma suffered by those with mental illness. Perhaps not as many as there should be but still, some.

The stigma associated with schizophrenia is unlike that of other mental illnesses IMHO - largely because of media portrayals of schizophrenia. I remember when asked why I was "on the sick" by a young lass I told her my diagnosis and she said "Oh, so are you going to kill us all then?" People often conflate schizophrenia with psychopathy too, in my experience. I don't think ADHD has the same baggage, for example.

Adhd is almost trendy now. People are realizing it isn't all deficit, but a trade off for improved abilities in some areas at the cost of the ability to follow a schedule and stay on mundane tasks.

Schizophrenia is associated with creativity and divergent thinking. Some research is suggesting an insult in gestation from the mother's autoimmune response derails the development of the brain, sidestepping the awesome brain that was in development. More research is needed. Unfortunately, western culture prefers likeness, and doesn't embrace diversity.

Schizophrenia is far too horrific an illness to see any obvious selective advantage. Yet, the culprit genes have been transmitted from generation to generation, even in Einstein's family. What gives?

First, it is not helpful to look upon schizophrenia as a simple disease. About a hundred suspect genes have been fingered. One of these genes - COMT - has a variation that enhances thought processing in one context but disrupts it in another. Another gene - DISC 1 - helps integrate neurons into the mature brain.

In this context, schizophrenia can be seen as the breakdown in the processes responsible for building and maintaining a complex brain.

Schizophrenia may also be seen as part of a spectrum. At the schizophrenia extreme, the brain is far too active for its own good, characterized by runway thoughts such as psychotic delusions. A lighter version may well be schizotypal personality disorder, characterized by various oddball behaviors and "magical thinking." Tone this down a bit more and we may be talking about eccentrics who think outside the box.

Nancy Andreasen MD, PhD of the University of Iowa describes Einstein as having having schizotypal traits, as well as a son with schizophrenia. Her original enquiry into creativity involved looking for a schizophrenia connection (also citing Newton and James Watson) but very quickly changed to bipolar.

There may be another aspect to "schizophrenia lite." The book, "A Beautiful Mind," chronicles the life of Nobel Laureate John Nash. His breakthrough accomplishments occurred as a young adult, before his outbreak of schizophrenia. But as the book makes clear, there is no way we can describe an apparently healthy John Nash as "normal." Even in a profession notorious for its eccentrics, Nash was very much an outsider.

We tend to think of mental illness as a complete break with reality or rationality, but these breaks don't just happen overnight. Subtle symptoms may manifest many years earlier, what the experts describe as "prodromal" states. Could Nash's "beautiful mind" be attributed to such a state? Who knows?

http://www.mcmanweb.com/darwinian_challenge.html

Fallible wrote:Sounds to me like the young lass was just your average ignorant person. It happens over pretty much anything - I used to be a librarian, and when I told people, their usual response was 'so you sit and stamp books all day?' In reality, librarians don't tend to stamp books at all (library assistants do that) - they are cataloguing, classifying, conserving, purchasing, budgeting, advertising, liaising, etc etc etc. I've also had to explain to several people that yes I'm an atheist but no, I don't believe that God does not exist. Sadly most people are simply astoundingly ignorant about anything which occurs just outside of their tiny sphere of knowledge and have overly simplistic or flat out erroneous views as a result.

But they didn't think "you're a librarian so you're a homicidal risky shuffle." They just thought you have a dull job. Hardly comparable when it comes down to the important issue - ie. the perception in society that schizophrenics are more likely to commit violent acts. The article at the top of the page details how many films depict schizophrenics as being homicidal. The way schizophrenic homicides "make the news" is also pertinent. I can't fully explain the prejudice against schizophrenics but I know I hide my illness from people I meet. I wonder at what point I would risk disclosure to a new friend. The situation sucks.

You misunderstand. I'm not trying to compare a dull job with a mental illness. I'm saying that people are generally stupid/ignorant, and this means they deal in clichés and stereotypes. Being vehicles of entertainment for these idiots, film by and large is going to pander to their simplistic views. Yes, it sucks, but you're hardly alone in being misunderstood by mass media.

being confused with murderous psychopaths is a little more than your average fallout from being misrepresented. Those poor librarians...not.