Psychiatric Tales

September 24, 2009 10:17 AM

Schizophrenia, a story from Darryl Cunningham's forthcoming Psychiatric Tales.
posted by Artw (30 comments total)

Thank you for posting this. One of my best friends has schizophrenia, and this is pretty much right on.
posted by FishBike at 10:23 AM on September 24, 2009 [2 favorites]

Good stuff.

Related: The Icarus Project
posted by Joe Beese at 10:25 AM on September 24, 2009

Previously
posted by Artw at 10:28 AM on September 24, 2009

About the crimes by the mentally ill being over-reported: Yes, due to fear but it's not clear to me that it's unjustified, in a sense.

Generally speaking, I know some methods to avoid being killed by the mentally non-ill. Stay away from dangerous areas, don't sleep with that angry dude's wife, don't be super-rich and write a will to my new, sketchy wife, etc. Killers, while dangerous, are mostly rational or at least predictable.

Someone whose "reality is twisted and distorted in bizarre ways" is a lot less predictable. So while they may only rarely kill someone, the victim has less of a chance of seeing it coming.
posted by DU at 10:33 AM on September 24, 2009

Sufferers of schizophrenia are no more dangerous than anyone else. Don't believe me? Then look in the paper and you'll see that most crimes are committed by the sane.

That's completely ridiculous. Here, let's make a small substitution and see if we can spot the fallacy:

Serial killers are no more dangerous than anyone else. Don't believe me? Then look in the paper and you'll see that most crimes are committed by people who are not serial killers.

I'm all for diminishing irrational fear of crazy people, but the way to do it is not to be irrational yourself. Sure, the media goes overboard in reporting violence by the insane, but that does not mean insane people are no more dangerous than anyone else, it just means it's a hot-button topic. So is terrorism, but I don't think you'd get very far telling people "terrorists are no more dangerous than anyone else." Try providing useful statistics instead of meaningless rhetoric.

Aside from that, a good, informative comic.
posted by languagehat at 10:45 AM on September 24, 2009 [7 favorites]

I'm with DU on this one. A young schizophrenic man whom I worked with (he was quite early onset) said of his destruction of a sliding glass door with a pipe, "The voice told me I had to destroy my friend or destroy the door." He made the right decision (as well as you can in that situation), but the random element makes it harder to avoid the potential violence.
posted by adipocere at 10:46 AM on September 24, 2009 [1 favorite]

(Just noticed that two of my top 3 "rational" justifications of murder involve untrustworthy wives. Chalk that up to my recent Agatha Christie kick not my rampant misogyny please.)
posted by DU at 10:51 AM on September 24, 2009

> Someone whose "reality is twisted and distorted in bizarre ways" is a lot less predictable. So while they may only rarely kill someone, the victim has less of a chance of seeing it coming.

Back years ago, an apartment complex I lived in housed a schizophrenic. A really nice guy, and even worked at being a spokesman for the mentally ill and a role model for his peers. On good days we'd sit on the balcony and chat about music, about his activities, about the town. But when he slid off his meds, or the meds stopped working, or for some other reason things turned bad, he wasn't a nice guy any more. He'd get shouty, play the same side of the same record around the clock at concert levels for days straight, and have his episodes. And getting better wasn't easy because, well, when he could see things a little clearer again there was all this stress from realizing he'd have to live in the messes he'd made, messes his caseworker would note on his record. Stress from the (real) ill will he knew he'd caused in the neighborhood. Because he really did try to be a nice guy.

Even in his darkest moments, he wouldn't lash out on others. Shout and throw things, yes, but not at people. And it didn't take a lot of time to learn how to tell when one of his bad spells was coming. He could be a hard guy to handle, a textbook case of somebody whose hard life was beyond conscious control, but he wasn't unpredictable either. The mentally ill aren't unpredictable unless you've tuned 'em out and ensured they're not noticed until they're hurting others.
posted by ardgedee at 10:54 AM on September 24, 2009 [7 favorites]

The mentally ill aren't unpredictable unless you've tuned 'em out

It's promising to know victims of random acts of violence would have been better prepared had they simply acclimated to the whims of their assailants. I'll tell my friend that the next time he's in the hospital again when someone throws a bucket at him from ten stories up and begins screaming about the devil.
posted by Christ, what an asshole at 11:17 AM on September 24, 2009

So while they may only rarely kill someone, the victim has less of a chance of seeing it coming.

Someone who is violently psychotic is more likely to have already committed the crime and been caught.
posted by StickyCarpet at 11:43 AM on September 24, 2009

Someone whose "reality is twisted and distorted in bizarre ways" is a lot less predictable. So while they may only rarely kill someone, the victim has less of a chance of seeing it coming.

I don't know if this is a great argument. Any victims of violence, by definition, did not see it coming with far enough advance notice to extricate themselves from the situation. Are you saying that people with schizophrenia, though they rarely become violent, are more "successful" in the violence they do begin to commit due to their distorted perceptions?

Personally, I'd be more concerned by the person with a firm grip on reality who is using that clear thinking in the service of trying to attack me.
posted by specialfriend at 11:47 AM on September 24, 2009

> It's promising to know victims of random acts of violence would have been better prepared had they simply acclimated to the whims of their assailants.

That's not what I meant at all, and I'm sorry for your friend.

But to put it in rougher terms, people don't spontaneously go crazy and kill people. Violence stemming from mental illness is preceded by a history of mental illness. Some measure of supervision, treatment, and community awareness of that mental illness, preferably without social persecution, can go a long way to provide preemptive intervention with the mentally ill before they hurt anybody.
posted by ardgedee at 11:50 AM on September 24, 2009 [2 favorites]

Great comic, I'm glad to see more from Darryl Cunningham. I particularly like the way the character switches in and out of negative b&w starting on the 4th page.

I think people are afraid of schizophrenics/mentally ill people in part because the ones we notice are the ones who are un-medicated. As mentioned above, I think lots of people (especially in cities) can point to moments where an angry, screaming person addressed them directly or threatened them and it is scary. It is a natural response to be afraid of someone who behaves bizarrely, whether it's harassing neighbors or being destructive or any number of behaviors that we don't really tolerate in public/in society. It is scary even if you understand that it is mental illness.

I don't think it's okay to stigmatize anyone. But I understand the fear... it must be frightening to see someone so sick, to find out someone you love is that sick, and to realize the very unpredictable nature of the medication that is keeping your loved one from being that very frightening stranger. However, whenever possible, it is of course better to strengthen your support group and rally around the person with schizophrenia than to isolate them.

So yeah - great comic.
posted by juliplease at 12:09 PM on September 24, 2009

That is the cruelest thing about mental illness, the ways in which it can make those who love you afraid of you--and you afraid of yourself. We do so little to help the mentally ill in this country, and it's so heartbreaking. No worse prison than a broken mind, is there?

Thanks for the link.
posted by emjaybee at 12:20 PM on September 24, 2009

I found this piece to be very realistic. Both my mother and my favorite first cousin were schizophrenic.

The only violence they ever engaged in was their final act, they killed themselves, and not in ways that might have caused physical harm to others.

I wonder why so many of the posters above seem obsessed with the possibility of violence. Is it because we are engaged in wars? Is it because violence is omnipresent in our "entertainment" -movies, tv, video games?
posted by mareli at 12:45 PM on September 24, 2009

I wonder why so many of the posters above seem obsessed with the possibility of violence.

I think it's because plenty of schizophrenic or otherwise mentally ill people are violent. It's not all of them, but the point is that you never know if a mentally ill person will become violent. With a person whose brain is functioning properly, you can at least hope that there will be some reason, or sign, that the person is going to be violent toward you. With a mentally ill person, because of their mental illness, they're not thinking like you are, it's very difficult to predict their actions, and as a result people are (reasonably) much warier about interacting with them. Obviously, this is not to say that all mentally ill people are violent, but mental illness is profoundly painful, and violence is a natural reaction to that pain.

Add in to that the fact that many people who have had casual encounters with the mentally ill can report an incident that is in some way violent. Usually, it's not physical, it might not even rise to the level of a threat, but it's still violent, something like shouting.

I think the reasons for this are a lot more obvious than "war" or "video games."
posted by Bulgaroktonos at 12:56 PM on September 24, 2009 [1 favorite]

Ian Chovil describes his experiences living with schizophrenia on his website.
posted by New Frontier at 1:22 PM on September 24, 2009

BC government has been slashing mental health support programs for the last decade, there basically aren't any left anymore. Populations of mental hospitals have dropped by 75%, and it's not because everyone was magically cured. It's so shortsighted it makes me want to cry, as the cost of supporting people suffering mental illness pales in comparison to the cost of violence, hospitalization, etc that society incurs when we neglect the most needy.

A schizophrenic may be violent, but they can't be blamed for that violence - we can only blame ourselves for failing to help them.
posted by mek at 1:23 PM on September 24, 2009

I wonder why so many of the posters above seem obsessed with the possibility of violence.

Because the relationship between violence and mental illness was a major (the major?) subject of the linked comic. It's directly addressed in at least ten panels. The linked material features images of a bloody axe, a dagger, and people engaged in a knife fight.

It's not surprising that the resulting discussion is about this subject.

Also, languagehat is right; the argument put forward in that panel is specious.
posted by mr_roboto at 2:17 PM on September 24, 2009

> A schizophrenic may be violent, but they can't be blamed for that violence - we can only blame ourselves for failing to help them.

What you say is true, but it's a small step from there to "...so don't say unpleasant things about them," which is unhelpful and tends to produce negative reactions. I understand the horror of schizophrenia (a good friend of mine has a schizophrenic brother, and my brother has a schizophrenic friend) and am appalled by the callousness of our response as a society to the problem of mental illness, but I also had to leave an Astoria apartment because a mother and her schizophrenic son moved in downstairs and he took to threatening my wife, banging on the door and shouting obscene insults and threats, etc. I felt terribly sorry for the mother (she lied to get into the building, knowing that she'd get thrown out as she had been everywhere else—my wife and I were not willing to wait for the eviction to go through), but come on, don't try to tell me I should be kindly and understanding to someone who's threatening my wife, and don't tell me the odds are that he won't actually carry out the threatened violence, because that's bullshit. Anybody who's willing to play the odds in a situation like that is crazy themselves.
posted by languagehat at 2:29 PM on September 24, 2009

Actually, it's not. The data shows that people with schizophrenia-- so long as they take their meds and don't take other drugs as well-- are no more likely to be violent than anyone else. However, if they *don't* take their meds or *do* take other drugs on top, they are actually more likely to be violent than other people.

Since, in real life, about half take other drugs and many have (quite understandable due to the side effects) periods of not taking their meds, the reality boils down to, yes, they are more likely to be violent than other people but this isn't inherent in the disorder.

I will post the citations if people like..
posted by Maias at 2:31 PM on September 24, 2009

Dangerousness and mental health: The facts

Key facts about violence

* Out of 1,564 cases of people convicted of homicide in England and Wales in the three years between April 1996 and April 1999, 164 (10 per cent) were found to have symptoms of mental health problems at the time of the offence. [1]
* In 2005, the total population in England and Wales was just over 53 million. It has been estimated that around 1 in 6 of the population will at any one time suffer from a significant mental health problem. [2] This means that around 8.8 million people in England and Wales suffer from a significant mental health problem at any one time. Comparing this figure with the 50-60 cases of homicide a year involving people with mental health problems [3], the data does not support the sensationalised coverage about the danger people with mental health problems present to the community.
* The vast majority of violent crime and homicides are committed by people who do not have mental health problems. In fact, 95 per cent of homicides are committed by people who have not been diagnosed with a mental health problem. [4]
* Contrary to popular belief, the incidence of homicide by people diagnosed with mental health problems has stayed at a fairly constant level since the 1990s at between 50 and 60 a year. [5]
* The fear of random, unprovoked attacks on strangers by people with mental health problems is unjustified. This has been highlighted by an American finding that patients with psychosis, living in the community, are 14 times more likely to be the victims of a violent crime than to be arrested for such a crime. [6]
* According to the British Crime Survey, close to 50 per cent of all victims of violent crimes believed that their offender was under the influence of alcohol. Around 18 per cent of victims believed that the offender was under the influence of drugs. Around 30 per cent of victims believed that the offender attacked them because they were under the influence of drugs or alcohol. In contrast, only one per cent of victims believed the violent incident happened because the offender was suffering from a mental illness. [7]
* People with mental health problems are more dangerous to themselves than they are to others. 90 per cent of suicides in the UK are committed by people in mental distress. [8]

posted by Artw at 2:36 PM on September 24, 2009 [4 favorites]

"Sufferers of schizophrenia are no more dangerous than anyone else. Don't believe me? Then look in the paper and you'll see that most crimes are committed by the sane."

That's completely ridiculous. Here, let's make a small substitution and see if we can spot the fallacy:

"Serial killers are no more dangerous than anyone else. Don't believe me? Then look in the paper and you'll see that most crimes are committed by people who are not serial killers."

I'm all for diminishing irrational fear of crazy people, but the way to do it is not to be irrational yourself. Sure, the media goes overboard in reporting violence by the insane, but that does not mean insane people are no more dangerous than anyone else, it just means it's a hot-button topic. So is terrorism, but I don't think you'd get very far telling people "terrorists are no more dangerous than anyone else." Try providing useful statistics instead of meaningless rhetoric.

I see your point, but your example is not a fair comparison. All serial killers and terrorists are by dangerous, by definition. Not all schizophrenics are dangerous. In fact, most aren't. Yes, there are particular dangers associated with insane and/or psychotic people that you won't find among normal people, but there are also particular dangers associated with being insane and/or psychotic, one of which facing a hostile society who thinks your disease equates you with serial killers and terrorists.
posted by granted at 2:45 PM on September 24, 2009 [4 favorites]

I think it's because plenty of schizophrenic or otherwise mentally ill people are violent.

Perception is everything. For every knife-wielding raving lunatic you notice, there are a dozen silent, motionless catatonics on park benches whom you walk by without a second glance.

Oh, that's a great comic, btw.
posted by scratch at 3:25 PM on September 24, 2009

Maias: I will post the citations if people like.

Yes, please do, and not because I disbelieve anything you wrote. I just have a personal interest in the subject and like to read things others have found useful and credible.

I wonder if there are any good statistics about violent acts committed by people with schizophrenia that break out acts against people trying to help them (family and friends, medical professionals, other authorities) vs. against random strangers? Because I've read a few articles about how the former group are especially frequent targets, and that's consistent with my experience too. But I haven't seen any statistics to back that up.

There's a certain logic to it as well. If you think there is some huge conspiracy to force you to do something you don't want to do (e.g. get treatment and take medication), then the people trying to force you to do that are a threat. It's not so much the reaction to the perceived situation that is disconnected from reality, but the perception of the situation itself. At least, that's how it has looked to me based on one friend with schizophrenia.
posted by FishBike at 3:31 PM on September 24, 2009

That is the cruelest thing about mental illness, the ways in which it can make those who love you afraid of you--and you afraid of yourself.

And then, even if you find medication that works well for you (which is not a given), a whole bunch of other issues emerge. Like you may remember many of the strange or terrible things you did while your condition wasn't under control, and feel tremendous embarrassment or guilt about those things.

After putting in the effort it takes to get control of a mental illness (not that "effort" alone is all it takes), you may find your friends have all abandoned you, your personal relationships are a mess, your job/career has fallen apart, your finances are a disaster, and on and on it goes. And you find yourself maybe thinking, why am I bothering to try, if *this* is all I have to look forward to?

Getting the mental illness problem under control is often just the first step in a long process of getting a normal life back.
posted by FishBike at 3:47 PM on September 24, 2009 [2 favorites]

Ignorance makes me really unhappy. Take your armchair psychology to another thread/forum. You obviously have little insight to mental illness, and have fallen victim to the stigma this comic is trying to dissuade people from. Oh, go on about how great the comic is, then post a comment on the one or very few cases of severe mental illness that has brushed your life.

*goes outside*
posted by captainsohler at 5:30 PM on September 24, 2009

> the reality boils down to, yes, they are more likely to be violent than other people but this isn't inherent in the disorder.

Yes, but in the real world we have to deal with real schizophrenics and not whatever may be "inherent in the disorder," and as you say, they often don't take their meds.

> I see your point, but your example is not a fair comparison.

It wasn't meant to be a "fair comparison," it was meant to illustrate the illogical nature of the original statement. I could have done it with X, Y, and Z placeholders, but putting it the way I did makes the fallacy abundantly clear. My point has nothing to do with percentages, it is purely about the logic involved. To say "Sufferers of schizophrenia are no more dangerous than anyone else. Don't believe me? Then look in the paper and you'll see that most crimes are committed by the sane" is to make a logical point (most crimes are committed by non-X, therefore X is not dangerous) that is completely wrong.

> Ignorance makes me really unhappy. Take your armchair psychology to another thread/forum.

Ad hominem bullshit makes me really unhappy. Take your emotional overreactions to another thread/forum. I'm sorry for whoever it is you know that's causing you to overreact, but your personal experiences do not trump those of others.
posted by languagehat at 5:44 PM on September 24, 2009

Here's the meta-analysis I just thinking of-- don't have time to post more, but this should include most of the most important studies.

The OR for homicide by people with schizophrenia is 19.5-- that's higher than the risk of lung cancer with smoking (OR = 10, typically), although there's some heterogeneity in the data.

The Mind statistics cited above are trying to elide these facts because the reality that most violence isn't committed by schizophrenics tells us nothing about whether schizophrenics are at greater risk of committing violent crimes than other people.

Personally, I believe that advocates do much better when they face unpleasant truths and don't pretend that links that exist and are widely replicated aren't real. They don't do their cause justice by doing this-- they reduce trust and by doing that you are actually reducing the chance that you can genuinely reduce stigma.
posted by Maias at 6:32 PM on September 24, 2009 [4 favorites]

I wonder if there are any good statistics about violent acts committed by people with schizophrenia that break out acts against people trying to help them (family and friends, medical professionals, other authorities) vs. against random strangers? Because I've read a few articles about how the former group are especially frequent targets, and that's consistent with my experience too. But I haven't seen any statistics to back that up.

I imagine quite a bit of it goes unreported. I've worked with many families who never reported the violence their children did to them or their property, and the agency I was with when I was working in the community with extremely mentally ill consumers with assaultive histories never pressed charges against a client when a case manager was assaulted, which happened relatively infrequently but did happen. Maybe a couple times a year a case manager got attacked. Those situations were resolved in-house, the case manager was given the choice to take as much personal time as necessary to recover, was offered counseling services, was encouraged to switch units to something lower impact for a while. You go into this type of job with a very clear understanding that this might happen.

Similarly, inside treatment facilities especially inpatient psych units it's just considered a working hazard. You go into the job understanding that at some point someone is going to attempt to assault you. You get trained, as I did, on safety protocols for how to prevent these situations from arising, de-escalate them when they do, or just protect yourself while doing your best not to harm the consumer if shit actually goes down. But you never took shit to the cops, never would press charges or witness against a consumer unless it was something totally egregious.
posted by The Straightener at 7:24 AM on September 25, 2009