April 2, 1999

An article on the front-page of the February 5 issue claimed that APA President Rodrigo Muņoz, M.D., had set straight the public record on violence and the mentally ill. Alas, this is not the case.

Instead, his claim that the mentally ill on average are no more violent than other citizens obscures the issues. If one takes the entire population of those with psychiatric disorders, his statement may be accurate, but in the case of Kendra Webdale, tragically killed in New York City by a man with a purported history of schizophrenia, the more relevant issue is the extent to which people with major mental disorders commit violence.

If one focuses on this more restricted group, there is ample evidence that such patients are indeed more violent than the general population. Swanson and his colleagues (1994), for example, using data from the Epidemiologic Catchment Area study, found that the presence of a major mental illness such as schizophrenia was a significant predictor of violence. This study was noteworthy for controlling a number of variables often overlooked in previous studies. In a large-scale review of this area, Rasanen and colleagues (1998) noted a number of studies showing that men with major mental illness were from 4 to 7 times more likely to commit a violent offense than those not so afflicted. In their own prospective follow-up of an unselected birth cohort (n=11,017) to age 26, these authors found that men with comorbid alcohol abuse and schizophrenia were 25 times more likely to commit a violent crime than those with no mental illness. Patients with schizophrenia but no alcoholism were less likely to commit violence, but the odds ratio was still 3.6 times higher than men without such illness. The risk of recidivism for those with comorbid illness was about 10 times higher than that of mentally healthy men.

While one must applaud the efforts of Dr. Muņoz and Ms. Flynn of the National Alliance on Mental Illness to destigmatize mental illness, I doubt that ignoring the relevant research data is helpful in the long term. Indeed, such an approach might lead caregivers to minimize the risks posed by those with major mental illness, substance abuse/dependence, and antisocial personality disorder, all high-risk categories. Further, such statements might lead those in control of the purse strings to deny funding for research into this vitally important area.

Finally, the description of the assailant as "mentally deranged" is odd, considering the apparent purpose of the article and the fact that Psychiatric News is the official newspaper of APA.

Charles E. Dean, M.D.
Minneapolis, Minn.