Mental Illness and Crime: Causation or Correlation?

From a lecture series presented by The Great Courses

When homicides make the news, particularly if it is a mass shooting, typically the public’s first reaction is that the culprit must be mentally ill. The media largely perpetuates this stereotype, as headlines commonly equate criminality with mental illness. But when it comes to mental illness and crime, can we always be so sure that the illness is to blame?

Crime scene on a rainy night with selective focus / high contrast image

Mysterious Plane Crash Attributed to Co-Pilot’s Depression

Whether or not a person has mental illness is often a source of speculation in the media, which will sometimes come to a conclusion before the facts are known.

In March 2015, Germanwings flight 9525 took off from Barcelona, heading to Dusseldorf. Half an hour after takeoff, the aircraft began a rapid descent.

All 150 people on board were killed when the plane crashed into the French Alps. This much is known: The pilot had left the cockpit and he was locked out as the plane crashed.

He can be heard on the flight recorder, pounding on the door. We also know that the co-pilot put the plane on autopilot, set to a very low altitude, and that crashed the plane into the mountains.

But what we still don’t know is exactly why the co-pilot set the autopilot to crash the aircraft.

Three days after the crash, the BBC declared that the co-pilot “wanted to destroy” the plane. CNN said that the co-pilot deliberately crashed the plane, and in a later editorial characterized the tragedy as an “accident waiting to happen.”

This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, on The Great Courses Plus.

It was quickly revealed that the co-pilot had a psychiatric health history, including prior treatment for depression in 2008. The New York Times worded it this way: “Lufthansa Says Germanwings Pilot Reported Deep Depression.” That word, “depression,” referring to a specific medical diagnosis, continued to dominate headlines about the incident.

And it was later confirmed, the co-pilot was being treated for depression. But was that the singular, main cause of the crash?

Depression is common, very common in fact, and it’s likely that people with depression fly planes, drive cars, operate machinery, perform surgery, and serve in the military or in the police force.

Very few of them commit crimes or crash their planes into the mountains. Saying that the co-pilot had depression really doesn’t explain anything. If there were blanket policies saying that people with depression should not be allowed to perform certain jobs, it would be unlikely, though, that anyone’s safety would be improved.

Mental Illness and Mass Shootings

Headlines about mass shootings in the United States have frequent speculations about the perpetrator’s mental health. After the Sandy Hook Elementary School shooting in 2012, Psychology Today asked, “Was Adam Lanza an Undiagnosed Schizophrenic?” with a subsequent headline, “And Could a Proper Diagnosis Have Averted the Newtown Massacre?”

Classroom in campus of university

The New York Times, in its opinion piece titled “Our Failed Approach to Schizophrenia,” said that Lanza’s acts of slaughter strongly suggest undiagnosed schizophrenia—a statement that’s patently false, as these kinds of acts of violence are not, in fact, diagnostic or even suggestive of any specific mental disorder.

Conservative provocateur Ann Coulter, in 2013, proclaimed unequivocally in a headline that “Guns Don’t Kill People—The Mentally Ill Do.” She quotes a statistic—that 31 percent to 61 percent of all homicides committed by “disturbed individuals” occur during their first psychotic episode.

Even in the unlikely event that the statistic is accurate, what are we supposed to do about it? What she seems to be suggesting is that we incarcerate people before they’ve been diagnosed, which is easy to say after a tragedy.

That’s called being a “Monday morning quarterback.” But unless we’ve got a crystal ball, it’s not so easy to tell in advance.

Ms. Coulter has bought into that misperception inspired by Jack Nicholson’s character in The Shining —that is, to put it bluntly, crazy people look crazy, and that mental illness equals criminal intent. The real world is not as simple as the headlines and the movie portrayals.

Learn more about why the mentally ill are viewed as violent perpetrators

Are Antidepressants the Culprit?

Here’s an ironic twist: headlines that blame tragedies or crimes not so much on the mentally ill but on their treatment. In 2017, a BBC documentary titled A Prescription for Murder made the case that it wasn’t depression or other mental illnesses that led people to commit crimes; it was their treatment with antidepressant medications.

Again, there’s no actual evidence of this. Antidepressants are in wide use in the United States and abroad. Though there can be side effects from these or any medicines, homicidal rage or violent acts are not caused by these medicines.

In fact, we know that people treated for depression are less likely to take their own lives in suicide. Media portrayals that convince people to not seek help for mental illness, or to stop their treatment, are much more likely to cause harm than prevent it.

Trends in Mental Illness Portrayals

There have been several studies looking at the portrayal of mental illness in the media. In 1997, researchers looked at the portrayal of characters with mental illness on television shows and found that they were often shown committing crimes, especially violent crimes.

The mentally ill, in these television roles, were 10 times more violent than other characters in their shows, and were 10 to 20 times more violent than real people with mental illness in the United States. Overall, mentally ill people from this TV sample had a negative impact on other characters, and a poor personal quality of life.

In 2003, another study looked at articles from about 2,000 newspapers, finding that the most common theme for the stories was danger—that is, how the mentally ill are dangerous to both themselves and others. There were relatively few stories about recovery or accomplishment.

Though the ratio of negative to positive stories did decline from 1989 to 1999, negative stories still highly outnumbered stories that portrayed mentally ill people in a positive way.

More recently, Emma McGinty and her team from Johns Hopkins published a study titled “Trends in News Media Coverage of Mental Illness in the United States, 1995-2014.” They looked at the content of 400 randomly selected news stories from both television and print media about mental illness culled from that time period.

We’re talking about big-name, well-known sources here, like The Wall Street Journal, The New York Times, major network evening news, these kinds of venues. Over half of the stories talked about violent behavior committed by the mentally ill, this despite the fact that, as reported by the U.S. Department of Health and Human Services, people with mental illness are 10 times as likely to be victimized by violence than the general population.

The researchers, sad to say, didn’t find any improvements in these trends over the 20-year period from which they culled the stories. If anything, more recent portrayals became more negative, potentially increasing the stigma against people with mental illness.

Learn more about the media’s take on mental health

Mental Illness and Stigmatization: A Vicious Cycle

Unfortunately, as the researchers pointed out, this lack of improvement can contribute to a reluctance among people with symptoms to seek treatment and to continue with their therapy once diagnosed.

Admittedly, this doesn’t mean that there is never a relationship between mental illness and crime, or mental illness and violence. The subject is a complicated issue.

A depressed teen boy holding a help sign while on the front steps of a house

Mental illness has a complex interrelationship with many other influences in a person’s life: early childhood experiences, poverty, medical problems, upbringing, and genetics. Rather than depression, a far more common correlation between mental illness and violent behavior is substance abuse; but unfortunately, substance abuse itself can either be a cause of, or a consequence of, mental illness.

Many people struggling with depression or anxiety turn to the illicit use of drugs to essentially self-medicate their pain. Exactly what is the cause and what is the effect remains complicated. More important, the issue of how we identify and treat mental illness in a way which both helps the patient and protects the patient, and protects the public, is a complex question.

Stigmas that drive those with mental health concerns into hiding and away from treatment are unlikely to help.

Speaking of treatment, the McGinty study also showed that mental illness is often portrayed in the media as hopeless. Only 47 percent of the stories reviewed even mentioned treatment, and successful treatment or recovery was only discussed 14 percent of the time.

The impression given is that people with mental illness cannot have a normal, productive life. And that’s not true.

Most people do recover, often with the help of therapy, medicines, and support from their families and friends. In 2013, the Associated Press added a section in their style book covering mental illness, intended to encourage journalists to cover these issues more fairly and accurately.

But, it looks like we still have a way to go.

From the lecture series The Skeptic’s Guide to Health, Medicine, and the Media, taught by Professor Roy Benaroch, M.D.

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